SSI

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.)]