Potomac Rugby Referee Performance Survey Form
Date of match *
MM
/
DD
/
YYYY
Referee Name *
Competition Level *
Venue
ARs
(if any)
Coach *
Home Team *
Home Team Red Cards *
(No. of red cards issued)
Home Team Yellow Cards *
(No. of yellow cads issued)
Away Team Red Cards *
Away Team Yellow Cards *
Final Match Score *
(Home-Away)
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:
Areas for improvement:
Referee Communication:
Consistency:
Questionable Decisions:
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
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.
Thank you for completing this survey.
Your feedback is integral to the growth and development of high quality referees!
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