Suffolk Soccer Interleague |SSI Referee Evaluation

SSI Game Evaluation/Incident Report

REFEREES, use this form to evaluate the game that you officiated
AND to report on ANY incidents that occurred during an Interleague game

COACHES, use this form to report on ANY incidents that occurred during an Interleague game
(Coaches, Please also submit Referee Evaluation Report)

The report will be sent to Suffolk Soccer Interleague. Submit one report/game

Report Submitted By: RefereeHome Coach Visiting Coach * *Required Fields
Referee or Coach Name: *
E-Mail Address: *
E-mail address should be of the form name@domain (eg. webmaster@suffolksoccer.org)
Game Date: * Game Time: *
Home Club Name: * Visiting Club Name: *
Home Team: * Visiting Team: *
Age Group/Division: *
Game Location: *
Scores:1st Half(Home-Visitor) Final Score(Home-Visitor):
Did the teams play Match: YesNo (If No, provide comments below)

Field conditions:
Were the fields properly lined: NoYes
Were there corner flags : NoYes
Were the nets properly secured : NoYes
Goals post properly anchored : NoYes

Team Assessment
Home Team Team arrived On Time NoYes Conduct of Coaches Acceptable NoYes Conduct of Players AcceptableNoYes Conduct of spectators AcceptableNoYes Team properly dressed(uniform)NoYes Did all the players have numbered uniforms: NoYes	Visiting Team Team arrived On Time NoYes Conduct of Coaches Acceptable NoYes Conduct of Players AcceptableNoYes Conduct of spectators AcceptableNoYes Team properly dressed(uniform)NoYes Did all the players have numbered uniforms: NoYes
Did the coach submit US Club passes and rosters.: NoYes	Did the coach submit US Club passes and rosters.: NoYes

Any Injuries: * NoYes
If yes who and what time did this happen. What was the injury:

Were any Red or Yellow cards issued: * NoYes
If yes, Name of individual being carded(Player/Coach), US Club Passcard # and infraction.:

Please list all events as they occurred:
[This applies to the events that led up to a yellow or red card being issued but even if no cards were issued
add anything you want Suffolk Soccer Interleague to know about this game:(Injuries, Conduct, Field, etc.)]