AFHL Official Game Incident Report

Division

Referee 1 - Official Submitting Report

First

Last

Referee 2 (if applicable)

First

Last

Linesperson 1

First

Last

Linesperson 2

First

Last

Date

Type of Game

Arena

Home Team

Visiting Team

Name of Offender

First

Last

Player or Team Official

Jersey Number

Role of Team Official

Offending Team

When infraction occurred

Time of Infraction (enter N/A if pre- or post-game)

Are there other reports being submitted related to this incident?

If Yes, how many other reports?

Was there an injury?

Status of injured player

RULE (enter of

Section

Subsection - Include the Rule Subsection violated or more details if you checked Other

Did the incident include an Allegation of Discrimination?

Provide all relevant information pertaining to the incident:

Details of Incident