/ United States Soccer Federation
Referee Report
This report must be sent within 48 hours after the completion of the game to the Competition Authority
Game / vs
Home Team / Score / Visiting Team / Score
State Association / / Cup/Division
Professional League / Age Group
Date of Game / Scheduled Time / am / pm
Field / Actual Kickoff / am / pm
Address / End of Game / am / pm
Score at Halftime / home / vs / away
Referee / Grade / 87654321 / id #
Assistant Referee #1 /

Grade

/ 87654321 / id #
Assistant Referee #2 / Grade / 87654321 / id #
Fourth Official / Grade / 87654321 / id #
Weather /

Field Conditions

Was the home team on the field on time? / Yes / NO / If not, how late /
Field Markings
/ Good / Fair / Poor
Was the visiting team on the field on time? / Yes / NO / If not, how late /
No. of Spectators
/ approx.
Player Passes / Conduct
of the home team / were / were not / received and checked / of Officials / Excellent / Good / Fair / Poor
of Players / Excellent / Good / Fair / Poor
of the visiting team / were / were not / received and checked / of Spectators / Excellent / Good / Fair / Poor
Line-up / Dressing Room
of the home team / is / is not / enclosed, available / for Referees / n/a / satisfactory / unsatisfactory
of the visiting team / is / is not / enclosed, available
4th Official Log / is / is not / enclosed, available / for Players / n/a / satisfactory / unsatisfactory
A Supplementary Referee Report explaining circumstances must accompany any unusual situations.
Serious injuries during the game:
Name / Pass # / Team / Nature of Injury
Name / Pass # / Team / Nature of Injury
Players cautioned during the game:
Unsporting Behavior (UB)Unsporting Behavior (UB-1A)Unsporting Behavior (UB-1B)Unsporting Behavior (UB-1C)Unsporting Behavior (UB-1D)Unsporting Behavior (UB-1E)Unsporting Behavior (UB-1F)Unsporting Behavior (UB-1G)Unsporting Behavior (UB-1H)Unsporting Behavior (UB-1I)Unsporting Behavior (UB-1J)Unsporting Behavior (UB-1K)Unsporting Behavior (UB-1L)Unsporting Behavior (UB-1M)Dissent (DT)Persistant Infringement (PI)Delays Restart of Play (DR)Fails to Respect Distance (FRD)Enters Without Permission (E)Leaves Without Permission (L)
Name / Pass # / Team / Type of Misconduct
Unsporting Behavior (UB)Unsporting Behavior (UB-1A)Unsporting Behavior (UB-1B)Unsporting Behavior (UB-1C)Unsporting Behavior (UB-1D)Unsporting Behavior (UB-1E)Unsporting Behavior (UB-1F)Unsporting Behavior (UB-1G)Unsporting Behavior (UB-1H)Unsporting Behavior (UB-1I)Unsporting Behavior (UB-1J)Unsporting Behavior (UB-1K)Unsporting Behavior (UB-1L)Unsporting Behavior (UB-1M)Dissent (DT)Persistant Infringement (PI)Delays Restart of Play (DR)Fails to Respect Distance (FRD)Enters Without Permission (E)Leaves Without Permission (L)
Name / Pass # / Team / Type of Misconduct
Unsporting Behavior (UB)Unsporting Behavior (UB-1A)Unsporting Behavior (UB-1B)Unsporting Behavior (UB-1C)Unsporting Behavior (UB-1D)Unsporting Behavior (UB-1E)Unsporting Behavior (UB-1F)Unsporting Behavior (UB-1G)Unsporting Behavior (UB-1H)Unsporting Behavior (UB-1I)Unsporting Behavior (UB-1J)Unsporting Behavior (UB-1K)Unsporting Behavior (UB-1L)Unsporting Behavior (UB-1M)Dissent (DT)Persistant Infringement (PI)Delays Restart of Play (DR)Fails to Respect Distance (FRD)Enters Without Permission (E)Leaves Without Permission (L)
Name / Pass # / Team / Type of Misconduct
Unsporting Behavior (UB)Unsporting Behavior (UB-1A)Unsporting Behavior (UB-1B)Unsporting Behavior (UB-1C)Unsporting Behavior (UB-1D)Unsporting Behavior (UB-1E)Unsporting Behavior (UB-1F)Unsporting Behavior (UB-1G)Unsporting Behavior (UB-1H)Unsporting Behavior (UB-1I)Unsporting Behavior (UB-1J)Unsporting Behavior (UB-1K)Unsporting Behavior (UB-1L)Unsporting Behavior (UB-1M)Dissent (DT)Persistant Infringement (PI)Delays Restart of Play (DR)Fails to Respect Distance (FRD)Enters Without Permission (E)Leaves Without Permission (L)
Name / Pass # / Team / Type of Misconduct
Unsporting Behavior (UB)Unsporting Behavior (UB-1A)Unsporting Behavior (UB-1B)Unsporting Behavior (UB-1C)Unsporting Behavior (UB-1D)Unsporting Behavior (UB-1E)Unsporting Behavior (UB-1F)Unsporting Behavior (UB-1G)Unsporting Behavior (UB-1H)Unsporting Behavior (UB-1I)Unsporting Behavior (UB-1J)Unsporting Behavior (UB-1K)Unsporting Behavior (UB-1L)Unsporting Behavior (UB-1M)Dissent (DT)Persistant Infringement (PI)Delays Restart of Play (DR)Fails to Respect Distance (FRD)Enters Without Permission (E)Leaves Without Permission (L)
Name / Pass # / Team / Type of Misconduct
Players sent off the field: (Player passes must be retained after the game and returned to the competition authority with a copy of the RefereeReports)
Serious Foul Play (SFP)Violent Conduct (VC)Denies Goal - Handling (DGH)Denies Goal - Foul (DGF)Abusive Language (AL)Second Caution (2CT)Spits at any Person (S)
Name / Pass # / Team / Type of Misconduct
Serious Foul Play (SFP)Violent Conduct (VC)Denies Goal - Handling (DGH)Denies Goal - Foul (DGF)Abusive Language (AL)Second Caution (2CT)Spits at any Person (S)
Name / Pass # / Team / Type of Misconduct
Serious Foul Play (SFP)Violent Conduct (VC)Denies Goal - Handling (DGH)Denies Goal - Foul (DGF)Abusive Language (AL)Second Caution (2CT)Spits at any Person (S)
Name / Pass # / Team / Type of Misconduct
I received / the Referee fee of $ / Referee Signature
I did not receive / the Referee fee of $ / Phone # / () - x / Date / //
For any Referee assault or abuse, severe injury, or other substantial or unusual occurrences
a copy of the RefereeReport and Supplementary Report must be sent to your State Association