Auckland Rugby League Referees' Association
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Match Report
Please use the form below to submit a Match/Judicial Report. Please complete all fields
Team Name
Other Team Name
Grade
Ground
Date
Time
Alleged Offender
Club
Player Ordered Off?
Yes
No
Match Called Off?
Yes
No
When Did The Offence Occur?
1st Quarter
2nd Quarter
3rd Quarter
4th Quarter
Offence Type (Select all that apply)
Tripping
Kicking
Striking
Head High Tackle
Dangerous Throw / Tackle
Dropping Knees
Offensive Behaviour / Language
Referees / Match Officials Abuse
Re-entering Field of Play
Bringing game into disrepute charge
Citings
Side-line Eviction
Type Of Play
Player Injured?
Yes
No
Player Spoken To or Warned?
Yes
No
Team Spoken To or Warned?
Yes
No
Did Player Immediately Leave Field?
Yes
No
Player Immediately Go To Changing Room?
Yes
No
Events Prior To Send Off
The Incident
Events Following Send Off
Name
Designation
Phone
Email
*
Security Code
*
(not case sensitive.)
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