Match Incident Report Form
Note: This form repeats to allow for multiple instances. If no (more) incidents to report, you can close the window.

When completing the incident report, keep in mind the following:

1. State the facts of the foul play - not your opinion.

2. Be clear about the circumstances surrounding the reason for the card. For example, "the blue player struck the red player with a closed fist in the side of the face."

3. To the extent possible, give information on the result of the foul play. For example, "the red team replaced their normal kicker due to blue's foul play, and his replacement struggled and the team missed opportunities for points."

4. Provide specific, concise information on the foul play - where on the field did the offense occur? Was the the offense committed in open play, tackle/ruck, maul, scrum, lineout? How far from the play were you? Was your view unobstructed? Was there an injury?

Incident Date *
Incident Time
Time indicates minute in the match (e.g. 42')
Your answer
Offending Party's Name *
Your answer
Offending Party's Registration (CIPP) Number
Your answer
Offending Party's Club *
Your answer
Rugby Colorado Match?
Rugby Colorado administers all youth and high school matches. Please be aware of the sanctioning body for the match. This controls how disciplinary committees carry out their reviews of incidents.
Disciplinary Action [Card] *
Description of the Incident *
Your answer
Your answer
Submitter's Name *
This is the name of the person submitting the report.
Your answer
Submitter's E-mail Address *
Your answer
Referee of the Match
Note: Response required only if the referee is not the submitter
Your answer
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.