Potomac Rugby Referee Performance Survey Form
Date of match *
MM
/
DD
/
YYYY
Referee Name *
Your answer
Competition Level *
Venue
Your answer
ARs
(if any)
Your answer
Coach *
Your answer
Home Team *
Your answer
Home Team Red Cards *
(No. of red cards issued)
Your answer
Home Team Yellow Cards *
(No. of yellow cads issued)
Your answer
Away Team Red Cards *
Your answer
Away Team Yellow Cards *
Your answer
Final Match Score *
(Home-Away)
Your answer
Please score the referee's performance based on the following criteria:
Please score the referee's performance based on the following criteria: *
Excellent
Above Average
Average
Below Average
Poor
Tackle
Ruck
Maul
Scrum
Advantage
Offside
Lineouts
Overall
Areas well refereed:
Your answer
Areas for improvement:
Your answer
Referee Communication:
Your answer
Consistency:
Your answer
Questionable Decisions:
Your answer
Would you like to be contacted by our Development Officer to discuss the referee's performance? *
If yes, then please provide your contact info:
email and/or phone number
Your answer
Video review is invaluable to the development of our referees. Please attach a link to any videos that you have available for us to review here along with any time stamps at which you would specifically like for us to concentrate.
Your answer
Thank you for completing this survey.
Your feedback is integral to the growth and development of high quality referees!
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