U.S. Soccer Federation Referee Program
Referee Report
June 2012
Complete and submit this form to the appropriate competition authority (e.g., local league, tournament director, cup coordinator, etc.) as directed. If needed, and in addition to the U.S. Soccer Referee Report, the U.S. Soccer Supplemental Referee Report can be used for instances of referee assault, referee abuse, dismissal of team officials, sending-off offenses, serious injuries, game abandonment or other substantial occurrences.
Home Team: / Score:Away Team: / Score:
Association / League: / Select:ENYSYSA - State CupENYSYSA - Premier LeagueNew York - Thruway LeagueENYSYSA - Rising Stars Soccer LeagueNYW - Central New York Junior Soccer AssociationENYASA - Central New York State Soccer LeagueENYASA - United States Club SoccerUnknown / Unknown
Division / Age Group: / SelectBOYSGIRLSCOEDMENWOMEN- SelectAdultunder 19under 18under 17under 16under 15under 14under 13under 12under 11under 10under 9under 8Over 30Over 40under 21
Game Number:
Game Date:
Referee: / Grade:
Assistant Referee 1: / Grade:
Assistant Referee 2: / Grade:
Fourth Official: / Grade:
Cautions / Yellow Cards:
# - Name / Pass / ID Number / Team / Misconduct Code– / Select -UB - Unsporting BehaviorDT - Dissent by word or ActionPI - Persistent InfringementFRD - Failure to Rspct DstnceE - (Re)Entering w/o PermissionL - Leaving field w/o PermissionDR - Delaying the Restart
– / Select -UB - Unsporting BehaviorDT - Dissent by word or ActionPI - Persistent InfringementFRD - Failure to Rspct DstnceE - (Re)Entering w/o PermissionL - Leaving field w/o PermissionDR - Delaying the Restart
– / Select -UB - Unsporting BehaviorDT - Dissent by word or ActionPI - Persistent InfringementFRD - Failure to Rspct DstnceE - (Re)Entering w/o PermissionL - Leaving field w/o PermissionDR - Delaying the Restart
– / Select -UB - Unsporting BehaviorDT - Dissent by word or ActionPI - Persistent InfringementFRD - Failure to Rspct DstnceE - (Re)Entering w/o PermissionL - Leaving field w/o PermissionDR - Delaying the Restart
– / Select -UB - Unsporting BehaviorDT - Dissent by word or ActionPI - Persistent InfringementFRD - Failure to Rspct DstnceE - (Re)Entering w/o PermissionL - Leaving field w/o PermissionDR - Delaying the Restart
– / Select -UB - Unsporting BehaviorDT - Dissent by word or ActionPI - Persistent InfringementFRD - Failure to Rspct DstnceE - (Re)Entering w/o PermissionL - Leaving field w/o PermissionDR - Delaying the Restart
– / Select -UB - Unsporting BehaviorDT - Dissent by word or ActionPI - Persistent InfringementFRD - Failure to Rspct DstnceE - (Re)Entering w/o PermissionL - Leaving field w/o PermissionDR - Delaying the Restart
– / Select -UB - Unsporting BehaviorDT - Dissent by word or ActionPI - Persistent InfringementFRD - Failure to Rspct DstnceE - (Re)Entering w/o PermissionL - Leaving field w/o PermissionDR - Delaying the Restart
– / Select -UB - Unsporting BehaviorDT - Dissent by word or ActionPI - Persistent InfringementFRD - Failure to Rspct DstnceE - (Re)Entering w/o PermissionL - Leaving field w/o PermissionDR - Delaying the Restart
– / Select -UB - Unsporting BehaviorDT - Dissent by word or ActionPI - Persistent InfringementFRD - Failure to Rspct DstnceE - (Re)Entering w/o PermissionL - Leaving field w/o PermissionDR - Delaying the Restart
Send Offs / Red Cards & Dismissals:
# - Name / Pass / ID Number / Team / Misconduct Code– / Select -SFP - Serious Foul PlayVC - Violent conductS - Spitting at any personDOGSO - Deliberate HandlingDOGSO - By commiting FoulAL - Abusive Language2CT - 2nd CautionIB - Irresponsible Behavior
– / Select -SFP - Serious Foul PlayVC - Violent conductS - Spitting at any personDOGSO - Deliberate HandlingDOGSO - By commiting FoulAL - Abusive Language2CT - 2nd CautionIB - Irresponsible Behavior
– / Select -SFP - Serious Foul PlayVC - Violent conductS - Spitting at any personDOGSO - Deliberate HandlingDOGSO - By commiting FoulAL - Abusive Language2CT - 2nd CautionIB - Irresponsible Behavior
– / Select -SFP - Serious Foul PlayVC - Violent conductS - Spitting at any personDOGSO - Deliberate HandlingDOGSO - By commiting FoulAL - Abusive Language2CT - 2nd CautionIB - Irresponsible Behavior
– / Select -SFP - Serious Foul PlayVC - Violent conductS - Spitting at any personDOGSO - Deliberate HandlingDOGSO - By commiting FoulAL - Abusive Language2CT - 2nd CautionIB - Irresponsible Behavior
Name: / Date:
USSF ID Number:
Phone Number:
E-Mail Address: