PRESCRIBED FORM 21 - ABANDONED MATCH REPORT

PRESCRIBED FORM 21 - NEPEAN F.A. INC. ABANDONED MATCH REPORT
Reporting an abandoned match must be submitted in the first instance by telephone to the Operations Manager - 0407 123 352

This form must be lodged by the home team (or team named first on the team sheet) by:

Weekend Fixture - 9pm on the day of the incident

Mid-Week Fixture - 5pm on the following day of a mid-week fixture.

Please see below for reporting details of both clubs involved in an abandoned match.

MATCH DETAILS
Home Team *
Away Team *
Age Group *
Division *
Date of Match *
Time of Abandonment *
Home Team Score at time of abandonment *
Away Team Score at time of abandonment *
Venue Name & Field #: *
REFEREE DETAILS
Referee First Name *
Referee Surname *
Status Of Referee *
REASON FOR ABANDONMENT

Please select one of the following
Reason for Abandonment *
1. EXTRA INFORMATION & INSTRUCTIONS TO COMPLETE SUBMISSION:

PLAYER OR SPECTATOR BEHAVIOUR - a separate & full report must be submitted by the following people from BOTH the home and the away team.

The clubs may submit witness statements from other persons present at the game if desired. The reports are to be submitted to the Association’s office by the close of business (5:00 pm) on the Wednesday following the incident if a weekend game, or within 72 hours of the completion of the match, if played mid-week.

a.       Team manager

b.       Team coach

c.       Team captain

d.       Game marshal

e.       Match Referee & Assistants (NRG will forward official reports. If an unofficial or club referee was used, the club who supplied that referee must co-ordinate the submission of their reports)

f.         Ground Official

2.       PLAYER OR SPECTATOR SERIOUS INJURY - a brief report from the host club should be submitted indicating which player was injured,   whether or not an ambulance was called and at what point in the game the match was abandoned. The club to which the injured player belongs should submit a serious injury/accident report, however, that report does not form part of the abandoned match report process.

3.       REFEREE ABANDONED MATCH DUE TO WEATHER CONDITIONS – No extra reports are necessary

4.       VENUE FAILURE (LIGHTS OR SPRINKLER MALFUNCTION, OR PROBLEM WITH PITCH DISCOVERED AFTER KICK OFF) – home team should submit a brief report on what part of the venue malfunctioned to cause the abandonment.

NB: FINES APPLY FOR FAILURE TO REPORT ABANDONED GAMES
Provide extra information, as per the above instructions here:
You may also upload extra documents here
Name of Person Submitting Report *
Position or Role in Club (Must be a club committee member) *
Daytime Contact Phone Number: *
Email Address *
Please click "Print Form" to save a copy or print a copy of your report before sending to us.
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PRESCRIBED FORM 21 - NEPEAN F.A. INC. ABANDONED MATCH REPORT

Reporting an abandoned match must be submitted in the first instance by telephone to the Operations Manager - 0407 123 352

This form must be lodged by the home team (or team named first on the team sheet) by:

Weekend Fixture - 9pm on the day of the incident

Mid-Week Fixture - 5pm on the following day of a mid-week fixture.

Please see below for reporting details of both clubs involved in an abandoned match.