ESFA Referee Send-off / Incident Report

Send-off and Incident Report

Please Note
This form is to be used to report all send-offs of players and team officials (including two cautions) as well as spectator issues and other match incidents (e.g. no line markings, dangerous field conditions, etc.).

Single Cautions are not reported here.

Please provide a detailed description of any incidents.
State all facts, events and circumstances of any such incident relating to the match even if it occurred before, after or during half time of the match.

The report must only include the facts about the incident that occurred. It must not include
any comment on matters of opinion that the Referee may have in relation to the incident.

This report must be submitted by 9am Monday for a weekend match or
by 12 noon the day following a mid-week match.
Your Name*
Date of Match*

DayMonthYear
Competition*
Men's*
Junior Boys*
Women's*
Junior Girls *
Role*
Cup
Final Score*
Home Team*
Away Team*
Non-ESFA Club
Type of incident*
This report is used when either players or team officials have been sent off.
This report covers incidents such as post-match issues with team officials,
serious injury to a player, drinking alcohol in the technical area or near the
field, etc.. For incidents involving spectators please use "Spectator Incident".
This report is used when there has been improper behaviour or
abusive language directed towards you or a colleague by spectators.
This report is used to report incorrect field setup, issues
with RTOs, player ID issues, field safety, etc.

Details of the {IncidentType}
Persons Name
FFA Number
Team
Which Team(s)
When Did It Happen
Shirt Number
Team Name
If both teams are from one Club enter Blue, sharks, (Sat), etc.
Match Time*
Score at Time
Offence Code*
R1 Offence
R2 Offence
R3 Offence
R6 Offence
Was this offence against you or another referee?
Position
Lead Up
Incident
Post-sanction Incident

Your Details
FFA Number
E-mail
example@example.com
By clicking on the "Submit" button you acknowledge and agree that:
1. you are the match official whose FFA Number and e-mail address are entered above; and
2. the report is an accurate description of the incident (or incidents) that you witnessed.
Further, you grant ESFA with approval to contact you for further information or additional reports as required.
Digital Signature

I certify that the information entered is true and correct and was entered by myself.
Date

DayMonthYear
DateHourMinutesAM/PM Option