Form B – Report of Assistant Referee (Ordering Off) First Name * Last Name E-mail Address: * Assistant Referees Union * Assistant Referees Phone Number * Players FULL NAME * Players CLUB * Venue * Date of Fixture * Grade * Players Playing Position * Players Number * Match Result (pts vs pts) Nature of Offence: Infringement of * Enter law # here with infringement details Period of game when incidence occurred *Select1st Half2nd HalfExtra Time Elapsed time in period Proximity of Assistant Referee to incidence (in metres) Score at the time (pts vs pts) Had any cautions been issued to individual? *SelectYesNo Had any cautions been issued in general? SelectYesNo Please give detailed report Was the incident ‘flagged’ by officially appointed Touch *SelectYesNo If yes, who? Was the opposition player injured? *SelectYesNo If yes, please give brief description Did he/she receive medical attention? *SelectYesNo Did he/she have to leave the field as a result of the injury? SelectYesNo Did the player ordered off accept the decision without dissent? SelectYesNo Advised to attend disciplinary hearing the following Tuesday? *SelectYesNo Referees Union Referees Name Referees Phone Number Verification Code: Enter Verification Code: * * Required Share this:FacebookXLike this:Like Loading...