Alberta Soccer Association

ALBERTA SOCCER ASSOCIATION

Governing Body of Soccer in the Province of Alberta Soccer Association

Commonwealth Stadium

11000 Stadium Road Edmonton, Alberta T5H 4E2

(780) 474.2200 Fax: (780) 474.6300

MISCONDUCT REPORT

Note: In all cases of alleged physical abuse or verbal threat of a game official whether before, during or after a game, the report(s) must be sent to the Alberta Soccer Association with a copy to the respective League/District Association within 48 Hours (2 working days).

PLEASE PRINT LEGIBLY

League: / Division: / Age Group:
Venue: / Kick Off Time: / Date:
Home: / Away:
(A) / I Dismissed # / Player’s Name: / ID #

OR

(B) / I Dismissed Team Officials’ Name: / Title:

OR

(C) / There was Spectator Interference / Name:
Team Affiliation (A) or (B) or (C) :
OR
(D) / I did not dismiss anyone during the match because the incident took
place before or after the match, as detailed in my report. (Please check) [ ]

THE PLAYER WAS SENT OFF FOR THE FOLLOWING REASON:

[ ]Serious Foul Play, as defined in FIFA Laws of the Game.

[ ]Violent Conduct, as defined in FIFA Laws of the Game.

[ ]Spits at an opponent or any other person.

[ ]Denies the opposing team a goal or an obvious goal-scoring opportunity by deliberately handling the ball.

[ ]Denies an obvious goal-scoring opportunity to an opponent moving towards the player’s goal by an offence punishable by a free kick or a penalty kick.

[ ]Uses offensive, insulting or abusive language and/or gestures.

[ ]Receives a second caution in the same match. (Persistent criticism or disputing of the Referee’s decision)

[ ]Boarding (indoor game only)

Check one or more of the following to accurately describe the actions

of the player/coach following the dismissal (if applicable):

[ ]Left the field without any further incident.

[ ]Did not leave immediately and continued to dispute the Referee’s decision.

[ ]Returned at the end of game to criticize and dispute the Referee’s decision.

REPORT CONTINUES ON NEXT PAGE

A Discipline Committee will review this report; therefore it is important that it

be clear, legible and accurate. Please be brief and factual.

The incident which came to my attention occurred minutes into the game and was as follows:

Name of Team:: Name of Team

Defending this Side Defending this Side

Report Prepared By: (check one)
Referee’s Name (Print) / [ ]
Assistant Referee #1 (Print) / [ ] / Signature of Official who prepared Report
Assistant Referee #2 (Print) / [ ] / Date:
4th Official (Print) / [ ] / Revised June 2004