UNITED STATES SOCCER FEDERATION
REFEREE REPORT
This report must be mailed within 48 hours after completion of game to proper authorities.
GAME / vs.Home Team / SCORE / Visiting Team / SCORE
State Association/ / Division/
Professional League / Age Group
Date of Game / 20
Field and Address / Scheduled Time / AM / PM
Actual Kick off / AM / PM
End of Game / AM / PM
Score at half Time / - / H / V
REFEREE / Grade / SSN / - / -
A. Referee #1 / Grade / SSN / - / -
A. Referee #2 / Grade / SSN / - / -
4th Official / Grade / SSN / - / -
Field Condition / ExcellentGoodFairPoor / Weather / SunnyPartly CloudlyCloudyRainySnowHailSleetv10 Degrees10 - 20 Degrees20 - 30 Degrees30 - 40 Degrees40 - 50 Degrees50 - 60 Degrees60 - 70 Degrees70 - 80 Degrees80 - 90 Degrees90 - 100 Degrees^100 Degrees SunnyPartly CloudlyCloudyRainySnowHailSleetv10 Degrees10 - 20 Degrees20 - 30 Degrees30 - 40 Degrees40 - 50 Degrees50 - 60 Degrees60 - 70 Degrees70 - 80 Degrees80 - 90 Degrees90 - 100 Degrees^100 Degrees SunnyPartly CloudlyCloudyRainySnowHailSleetv10 Degrees10 - 20 Degrees20 - 30 Degrees30 - 40 Degrees40 - 50 Degrees50 - 60 Degrees60 - 70 Degrees70 - 80 Degrees80 - 90 Degrees90 - 100 Degrees^100 Degrees
Was the home team on the field on time? / Yes / No / If not, how late? / Min. / No. of Spectators / approx.
Was the visiting team on the field on time? / Yes / No / If not, how late? / Min. / Marking of Field: / ExcellentGoodFairPoor
Players Passes of the home team were were not received and checked. / Conduct of Officials / Excellent Good Fair Poor
Players Passes of the visiting team were were not received and checked. / of Players / Excellent Good Fair Poor
Line-up of the home team is is not enclosed, not available. / of Spectators / Excellent Good Fair Poor
Line-up of the visiting team is is not enclosed, not available. / Dressing Room for Referee / Satisfactory Unsatisfactory
4th Official Game Log is is not enclosed, not available. / for Players / Satisfactory Unsatisfactory
A supplementary form explaining circumstances must accompany any unusual situations.
Serious injuries during the game
HOMEVISITING
Name / Pass No. / Team / Nature of Injury
HOMEVISITING
Name / Pass No. / Team / Nature of Injury
Players cautioned during the game
HOMEVISITING / Unsporting Behavior (UB)Dissent (DT)Persistant Infringement (PI)Delays Restart (DR)Fails to Respect Required Distance (FRD)Enters or Re-enters Field Without Permission (E)Deliberately Leaves Field Without Permission (L)
Name / Pass No. / Team / Type of Misconduct
HOMEVISITING / Unsporting Behavior (UB)Dissent (DT)Persistant Infringement (PI)Delays Restart (DR)Fails to Respect Required Distance (FRD)Enters or Re-enters Field Without Permission (E)Deliberately Leaves Field Without Permission (L)
Name / Pass No. / Team / Type of Misconduct
HOMEVISITING / Unsporting Behavior (UB)Dissent (DT)Persistant Infringement (PI)Delays Restart (DR)Fails to Respect Required Distance (FRD)Enters or Re-enters Field Without Permission (E)Deliberately Leaves Field Without Permission (L)
Name / Pass No. / Team / Type of Misconduct
HOMEVISITING / Unsporting Behavior (UB)Dissent (DT)Persistant Infringement (PI)Delays Restart (DR)Fails to Respect Required Distance (FRD)Enters or Re-enters Field Without Permission (E)Deliberately Leaves Field Without Permission (L)
Name / Pass No. / Team / Type of Misconduct
HOMEVISITING / Unsporting Behavior (UB)Dissent (DT)Persistant Infringement (PI)Delays Restart (DR)Fails to Respect Required Distance (FRD)Enters or Re-enters Field Without Permission (E)Deliberately Leaves Field Without Permission (L)
Name / Pass No. / Team / Type of Misconduct
Players sent off the field - player passes must be retained and returned to the proper authority with this report.
HOMEVISITING / Serious Foul Play (SFP)Violent Conduct (VC)Spits at Opponent or Other Person (S)Denies Goal Scoring Opportunity - Hand Ball (DGH)Denies Goal Scoring Opportunity - Free Kick (DGF)Offensive, Insulting, or Abusive Language (AL)Second Caution (2CT)
Name / Pass No. / Team / Type of Misconduct
HOMEVISITING / Serious Foul Play (SFP)Violent Conduct (VC)Spits at Opponent or Other Person (S)Denies Goal Scoring Opportunity - Hand Ball (DGH)Denies Goal Scoring Opportunity - Free Kick (DGF)Offensive, Insulting, or Abusive Language (AL)Second Caution (2CT)
Name / Pass No. / Team / Type of Misconduct
/ HOMEVISITING / Serious Foul Play (SFP)Violent Conduct (VC)Spits at Opponent or Other Person (S)Denies Goal Scoring Opportunity - Hand Ball (DGH)Denies Goal Scoring Opportunity - Free Kick (DGF)Offensive, Insulting, or Abusive Language (AL)Second Caution (2CT)
Name / Pass No. / Team / Type of Misconduct
I received / Phone # / () -
I did not receive / the referee fee of $ / .00 / Referee Signature : / Date: / / / 20
For serious assault, severe injury or other substantial occurrences, a photocopy must be sent to Federation Headquarters: 1750 E. Boulder St., Colorado Springs, CO 80909
State Association League Referee
UNITED STATES SOCCER FEDERATION
REFEREE REPORT
This report must be mailed within 48 hours after completion of game to proper authorities.
GAME / vs.Home Team
/SCORE
/Visiting Team
/SCORE
State Association/ / Division/Professional League / Age Group
Date of Game / 20 / Referee
Describe Any Unusual Incident:
Remarks:
Referee Signature: / Report Date: / / / 20
Phone #: / () - / SSN: / --