Disciplinary Report
Referee Name
*
First Name
Last Name
Email
*
example@example.com
Match Date
*
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Match (? vs ?)
Disciplinary Action Given
Yellow Card
Red Card
Sideline Problem
Name of Offender
Team of Offender
CIPP# of Offender
Law Contravened
9.1 Obstruction by charge or push the other player
9.2 Intentionally obstruct an opponent or interfere with play
9.3 Intentionally prevent an opponent from tackling
9.4 Intentionally prevent an opportunity to play the ball
9.5 Intentionally run into an off-side teammate to obstruct the opposition
9.6 Obstruct or interfere with an opponent while the ball is dead
9.7a Intentionally infringe any law of the game
9.7b Intentionally knock, place, push, or throw the ball with arm or hand from the playing area
9.7c Do anything that may lead the match officials to consider than an opponent has committed an infringement
9.7d Waste time
9.8 Team repeatedly commit the same offence
9.9 Player repeatedly infringe the laws
9.11 Reckless or dangerous play to others
9.12 Physically or verbally abuse anyone
9.13 Tackle an opponent early, late or dangerously
9.14 Tackle an opponent who is not in possession of the ball
9.15 Push, charge or obstruct an opponent not in possession of the ball
9.16 Charge or knock down an opponent carrying the ball without attempting to grasp that player
9.17 Tackle, charge, pull, push or grasp an opponent whose feet are off the ground
9.18 Lift an opponent off the ground and drop/drive payer so that their head and/or upper body contact the ground
9.19 Dangerous play in scrum
9.20 Dangerous play in ruck or maul
9.21 Player must not retaliate
9.22 Use cavalry charge or flying wedge
9.23 Attempt to kick the ball from the hands of the ball carrier
9.24 Use of excessive force to hand off an opponent
9.25 Intentionally charge or obstruct an opponent who has just kicked the ball
9.26 Players who lift a teammate must lower that player to the ground safely
9.27 Against the spirit of good sportsmanship
9.28 Not respecting the authority of the referee
9.29 Second Yellow Card
(select one law)
Incident Summary
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Description of Discipline and Action
Detailed description of incident, including reports from others
Other Comments
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