Identification of Officials

Referee: / Phone: /

Level 123456

Linesman: / Phone: / Level 123456
Linesman: / Phone: / Level 123456
Official who made the call:
Details of incident (one incident per report)
Period of Game: 123OTPre GamePost Game / Time of Period
Indicate to whom and why the penalty was assessed: (provide actual Rule number)
# / of the / HomeVisiting / team for rule
# / of the / HomeVisiting / team for rule
# / of the / HomeVisiting / team for rule
# / of the / HomeVisiting / team for rule
State what you saw happen, including relevant incidents leading up to and following the
penalty (additional sheets may be used).
Date: / Signature:
Print Name:
Mail game sheets along with the original score sheet. MUST be mailed within 24 hours of incident. Reports are to be sent to the appropriate person based upon the rule violation as indicated on the reverse side. If in doubt contact your local Referee-in-Chief or Referee Committee Member immediately.
Type of Report
GameMatchGross10-MinInjuryContinuation /

Date of Game

Place of Game
Category: NoviceAtomPeeWeeBantamMidgetJuvenileJuniorSeniorNovice FemaleAtom FemalePeeWee FemaleBantam FemaleMidget FemaleSenior Female HouseLeagueAAAABDevelopment Regular SeasonExhibitionPlayoffTournament

Home Team

/

Visiting Team

Part 1
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PHYSICAL HARASSMENT AND REFUSING TO START PLAY
Rule 13 c) / Entering Official’s Dressing Room
Rule 71 / Physical Abuse/Threaten Official
Rule 78 / Refusing to start play/Withdrawing Team
Rule 78 e) / Player or Team official refusing to leave
Rule 80 / Spitting on/at Official
Send to BCAHA Officer
Part 2 / MATCH PENALTIES
Rule 53 a)b) / Checking from behind
Rule 49 a) / Deliberate injury or attempt to injure
Rule 49 b) / Head butting
Rule 49 c) / Attempt or Deliberate kick
Rule 49 d) / Grab hair or headgear to punish or injure
Rule 49 e) / Use of facial protector/blocker as a weapon
Rule 49 f) / Attempt/Deliberate Butt ending or Injury by Butt ending
Rule 49 g) / Attempt/Deliberate Spearing or Injury by Spearing
Rule 49 h) / Deliberate attempt/Injury by Crosscheck, High Stick, Slashing
Rule 80 / Spitting
Rule 86 b)c) / Checking to the Head
Send to BCAHA District Director / Divisional Director
Part 3 / GROSS MISCONDUCTS
Rule 59 d) / Player/Team Official fighting Team Official
Rule 33 b) / Conduct making Travesty of the game
Rule 24 c) / Removes Helmet to fight
Rule 47 f) / Verbal taunts, insults, intimidation
Rule 49 b)f)g) / Head butt, Butt-end or Spear by Team official (No Injury)
Send to BCAHA District Director / Divisional Director
Part 4 / GAME MISCONDUCTS
Rule 31 c) / Second 10 Minute Misconduct in game
Rule 47 f) / Verbal taunts, insults, intimidation
Rule 59 / Roughing/Fighting
Rule 53 / Checking From behind
Rule 54 b) / Crosscheck above the height of the shoulders
Rule 86 / Checking to the Head
Various / Injury due to Penalized Infraction
Send to Association / League President or Designate
Part 5
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10 MINUTE MISCONDUCTS and MAJOR PENALTIES
Rule 31 b) / 10 Minute Misconduct assessed within 10 minutes of game’s conclusion
Rule 47 b) / Persistence in: -Disrespect of Official
-Obscene/Profane/Abusive Language
-Shooting puck out of reach of an Official
Rule 47 e) / Inciting
Rule 47 f) / 10 Minute Misconduct – verbal taunts/intimidation/discrimination
Send to Association / League President or Designate
Part 6 / MISCELLANEOUS
Jerseys missing STOP sign
Send to BCAHA President