Game Incident Report
Ohio Water Polo Referees Association (OWPRA)
Incident Report Form

THIS REPORT IS TO BE FILED WITHIN 48 HOURS OF THE INCIDENT

A referee (or head referee, if applicable) shall report any of the incidents listed below to OWPRA's Supervisor. (A copy of the completed form is also sent to OWPRA's Coaches' Representative.) To do so, simply complete this form and submit it using the "submit" button.

Note that items marked with an asterisk (*) are required.

Reportable incidents include (but may not be limited to):

1.) Red card (given to a player, coach or any other team official) before, during or after a game.

2.) Flagrant misconduct (brutality foul)

3.) Game exclusion (misconduct) foul for violence

4.) Game exclusion foul for misconduct (only if it involves obscene, abusive or threatening language, violent or persistent foul play, or disobedience or disrespect towards the referee; exiting the pool illegally is not a reportable incident).

5.) Player injury involving bleeding or requiring medical attention (minor injuries, including those involving ice, are not reportable). If in doubt, report it!

6.) Game protest (regardless of outcome)

7.) "Other" (at the referee's discretion, see #5 above)

Today's Date *
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Time
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Date of Incident *
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Time
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Your First Name *
Your answer
Your Last Name *
Your answer
Your E-mail *
Your answer
Your Phone Number (xxx-xxx-xxxx) *
Your answer
What "incident" are you reporting? *
If you selected "other" above, please explain.
Your answer
In the following text box, please describe completely the physical conditions under which the "incident" occurred. For example, where and when (date, time, location) did the "incident" occur, which teams were playing, when during the game did the "incident" occur, etc. *
Your answer
In the following text box, please describe the "incident" itself. This should include the name(s) of the individuals involved and a complete description of ALL circumstances surrounding the "incident." *
Your answer
If you have any additional information regarding the "incident" that was not included above, or if you want to make any comments about the "incident," please enter this information in the following text box.
Your answer
Submit
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