RED CARD / MATCH DAY MISCONDUCT FORM This form is to be completed by the umpire following the issuing of a Red Card or to report a Match day Misconduct Offence (MMO). The other umpire may comment if they wish see section 15 below. The – completed form should be signed and dated, and sent as soon as soon as possible (and in any event within 72 hours of the offence) by email or First Class post to the County Disciplinary Administrator as per the Jersey Hockey Website. Please tick appropriate box - Red Card - Match day Misconduct Offence Name and shirt no. of offender Is the player U18? YES / NO Name of offender’s club / affiliated body Date of Title of competition if applicable Name of opposition team Category of offence. If the offence is one where physical violence is used, attempted or threatened against another player or an umpire ie boxes (b) or (c) below, please also delete the two alternatives which do NOT apply □ a) physical violence was not used, attempted or threatened. □ b) physical violence was used, attempted or threatened to a player or any other person □ c) physical violence was used, attempted or threatened to an umpire or properly appointed tournament or match official. d) two separate, but duplicate, minor offences for which a yellow card was awarded for the first offence Full details of the offence Please state what was said and/ or done, and also clarify anything which might influence the penalty eg was the offence spontaneous or had there been previous concerns, were any apologies offered etc? If necessary please use an additional sheet. Name of umpire Qualification of Umpire (tick one box) Unregistered, L1, L2, L3, National Badge Telephone and email address of umpire Signature of umpire Date: Name of 2nd umpire Qualification of 2nd Umpire (tick one box) Unregistered, L1, L2, L3, National Badge Optional additional comments / endorsement by second umpire Please provide details of the incident. If necessary please use an additional sheet
RED CARD / MATCH DAY MISCONDUCT FORM This form is to be completed by the umpire following the issuing of a Red Card or to report a Match day Misconduct Offence (MMO). The other umpire may comment if they wish – see section 15 below. The completed form should be signed and dated, and sent as soon as soon as possible (and in any event within 72 hours of the offence) by email or First Class post to the County Disciplinary Administrator as per the Jersey Hockey Website. Please tick appropriate box - Red Card - Match day Misconduct Offence Name and shirt no. of offender Is the player U18? YES / NO Name of offender’s club / affiliated body Date of Title of competition if applicable Name of opposition team Category of offence. If the offence is one where physical violence is used, attempted or threatened against another player or an umpire ie boxes (b) or (c) below, please also delete the two alternatives which do NOT apply a) □ physical violence was not used, attempted or threatened. b) □ physical violence was used, attempted or threatened to a player or any other person c) □ physical violence was used, attempted or threatened to an umpire or properly appointed tournament or match official. d) two separate, but duplicate, minor offences for which a yellow card was awarded for the first offence Full details of the offence Please state what was said and/ or done, and also clarify anything which might influence the penalty eg was the offence spontaneous or had there been previous concerns, were any apologies offered etc? If necessary please use an additional sheet. Name of umpire Qualification of Umpire (tick one box) Unregistered, L1, L2, L3, National Badge Telephone and email address of umpire Signature of umpire Date: Name of 2nd umpire Qualification of 2nd Umpire (tick one box) Unregistered, L1, L2, L3, National Badge Optional additional comments / endorsement by second umpire Please provide details of the incident. If necessary please use an additional sheet
rcrf-red-card-report-form.docx