Referee

Please complete the below section for the match referee.

Referee Strengths/Improvements/Coaching points*

Must Note minimum 2 Dot Points

Referee Key Match Decision/s

Include Time - Describe Situation - Note Correct or Incorrect - Did this effect the match?

Referee Coaching Comments*

Include Time - Describe Situation - Note Correct or Incorrect - Did this effect the match?

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Assistant Referee 1

Please complete the below section for AR1

AR 1 Strengths/Improvements/Coaching Points*

Must Note minimum 2 Dot Points

AR 1 Key Match Decision/s

Include Time - Describe Situation - Note Correct or Incorrect - Did this effect the match?

Upload Images / Clips

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Assistant Referee 2

Please complete the below section for AR1

AR 2 Strengths/Improvements/Coaching Points*

Must Note minimum 2 Dot Points

AR 2 Key Match Decision/s

Include Time - Describe Situation - Note Correct or Incorrect - Did this effect the match?

Upload Images / Clips

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4th Official

4th Official Strengths/Improvements/Coaching Points*

4th Official Key Match Decision/s

Referee

Please complete the below section for the match referee.

Referee Teamwork*

Referee Teamwork
	Coaching Required (See comments below)	Basic Understanding	Meets Expectations	Exceeded Expectations	N/A
Prematch instructions	Referee Teamwork: Prematch instructions (Coaching Required (See comments below))	Prematch instructions (Basic Understanding)	Prematch instructions (Meets Expectations)	Prematch instructions (Exceeded Expectations)	Prematch instructions (N/A)
Communication during match (e.g. eye contact, discrete signals)	Communication during match (e.g. eye contact, discrete signals) (Coaching Required (See comments below))	Communication during match (e.g. eye contact, discrete signals) (Basic Understanding)	Communication during match (e.g. eye contact, discrete signals) (Meets Expectations)	Communication during match (e.g. eye contact, discrete signals) (Exceeded Expectations)	Communication during match (e.g. eye contact, discrete signals) (N/A)
Support for other match officials	Support for other match officials (Coaching Required (See comments below))	Support for other match officials (Basic Understanding)	Support for other match officials (Meets Expectations)	Support for other match officials (Exceeded Expectations)	Support for other match officials (N/A)

Referee LOTG Knowledge and Application*

Referee LOTG Knowledge and Application
	Coaching Required (See comments below)	Basic Understanding	Meets Expectations	Exceeds Expectations	N/A
Consistent Interpretations of Laws	Referee LOTG Knowledge and Application: Consistent Interpretations of Laws (Coaching Required (See comments below))	Consistent Interpretations of Laws (Basic Understanding)	Consistent Interpretations of Laws (Meets Expectations)	Consistent Interpretations of Laws (Exceeds Expectations)	Consistent Interpretations of Laws (N/A)
Correct and Consistent application of the Laws	Correct and Consistent application of the Laws (Coaching Required (See comments below))	Correct and Consistent application of the Laws (Basic Understanding)	Correct and Consistent application of the Laws (Meets Expectations)	Correct and Consistent application of the Laws (Exceeds Expectations)	Correct and Consistent application of the Laws (N/A)
Consistent Interpretations of Laws within technical area	Consistent Interpretations of Laws within technical area (Coaching Required (See comments below))	Consistent Interpretations of Laws within technical area (Basic Understanding)	Consistent Interpretations of Laws within technical area (Meets Expectations)	Consistent Interpretations of Laws within technical area (Exceeds Expectations)	Consistent Interpretations of Laws within technical area (N/A)
Correct and Consistent application of the Laws within technical area	Correct and Consistent application of the Laws within technical area (Coaching Required (See comments below))	Correct and Consistent application of the Laws within technical area (Basic Understanding)	Correct and Consistent application of the Laws within technical area (Meets Expectations)	Correct and Consistent application of the Laws within technical area (Exceeds Expectations)	Correct and Consistent application of the Laws within technical area (N/A)
Foul Recognition	Foul Recognition (Coaching Required (See comments below))	Foul Recognition (Basic Understanding)	Foul Recognition (Meets Expectations)	Foul Recognition (Exceeds Expectations)	Foul Recognition (N/A)
Differentiation between careless, reckless and excessive force	Differentiation between careless, reckless and excessive force (Coaching Required (See comments below))	Differentiation between careless, reckless and excessive force (Basic Understanding)	Differentiation between careless, reckless and excessive force (Meets Expectations)	Differentiation between careless, reckless and excessive force (Exceeds Expectations)	Differentiation between careless, reckless and excessive force (N/A)
Correct application of sanctions (e.g. SPA / DOGSO)	Correct application of sanctions (e.g. SPA / DOGSO) (Coaching Required (See comments below))	Correct application of sanctions (e.g. SPA / DOGSO) (Basic Understanding)	Correct application of sanctions (e.g. SPA / DOGSO) (Meets Expectations)	Correct application of sanctions (e.g. SPA / DOGSO) (Exceeds Expectations)	Correct application of sanctions (e.g. SPA / DOGSO) (N/A)
Did the referee deal with dissent appropriately (inc. correct application of sin bin)	Did the referee deal with dissent appropriately (inc. correct application of sin bin) (Coaching Required (See comments below))	Did the referee deal with dissent appropriately (inc. correct application of sin bin) (Basic Understanding)	Did the referee deal with dissent appropriately (inc. correct application of sin bin) (Meets Expectations)	Did the referee deal with dissent appropriately (inc. correct application of sin bin) (Exceeds Expectations)	Did the referee deal with dissent appropriately (inc. correct application of sin bin) (N/A)
Correct application of advantage (incl. signalling)	Correct application of advantage (incl. signalling) (Coaching Required (See comments below))	Correct application of advantage (incl. signalling) (Basic Understanding)	Correct application of advantage (incl. signalling) (Meets Expectations)	Correct application of advantage (incl. signalling) (Exceeds Expectations)	Correct application of advantage (incl. signalling) (N/A)

Referee Match Management*

Referee Match Management
	Coaching Required (See comments below)	Basic Understanding	Meets Expectations	Exceeded Expectations	N/A
Whistle technique	Referee Match Management: Whistle technique (Coaching Required (See comments below))	Whistle technique (Basic Understanding)	Whistle technique (Meets Expectations)	Whistle technique (Exceeded Expectations)	Whistle technique (N/A)
Confidence in decision making	Confidence in decision making (Coaching Required (See comments below))	Confidence in decision making (Basic Understanding)	Confidence in decision making (Meets Expectations)	Confidence in decision making (Exceeded Expectations)	Confidence in decision making (N/A)
Effective body language and signals	Effective body language and signals (Coaching Required (See comments below))	Effective body language and signals (Basic Understanding)	Effective body language and signals (Meets Expectations)	Effective body language and signals (Exceeded Expectations)	Effective body language and signals (N/A)
Communication with players - (i.e. steps theory)	Communication with players - (i.e. steps theory) (Coaching Required (See comments below))	Communication with players - (i.e. steps theory) (Basic Understanding)	Communication with players - (i.e. steps theory) (Meets Expectations)	Communication with players - (i.e. steps theory) (Exceeded Expectations)	Communication with players - (i.e. steps theory) (N/A)
Restart of play procedure (e.g. IDFK, DFK, dropball)	Restart of play procedure (e.g. IDFK, DFK, dropball) (Coaching Required (See comments below))	Restart of play procedure (e.g. IDFK, DFK, dropball) (Basic Understanding)	Restart of play procedure (e.g. IDFK, DFK, dropball) (Meets Expectations)	Restart of play procedure (e.g. IDFK, DFK, dropball) (Exceeded Expectations)	Restart of play procedure (e.g. IDFK, DFK, dropball) (N/A)
Management of ceremonial free kick (wall management)	Management of ceremonial free kick (wall management) (Coaching Required (See comments below))	Management of ceremonial free kick (wall management) (Basic Understanding)	Management of ceremonial free kick (wall management) (Meets Expectations)	Management of ceremonial free kick (wall management) (Exceeded Expectations)	Management of ceremonial free kick (wall management) (N/A)
Management of Penalty Kick	Management of Penalty Kick (Coaching Required (See comments below))	Management of Penalty Kick (Basic Understanding)	Management of Penalty Kick (Meets Expectations)	Management of Penalty Kick (Exceeded Expectations)	Management of Penalty Kick (N/A)
Management of injuries	Management of injuries (Coaching Required (See comments below))	Management of injuries (Basic Understanding)	Management of injuries (Meets Expectations)	Management of injuries (Exceeded Expectations)	Management of injuries (N/A)
Restart of play procedure after injury	Restart of play procedure after injury (Coaching Required (See comments below))	Restart of play procedure after injury (Basic Understanding)	Restart of play procedure after injury (Meets Expectations)	Restart of play procedure after injury (Exceeded Expectations)	Restart of play procedure after injury (N/A)
Management of Technical Area	Management of Technical Area (Coaching Required (See comments below))	Management of Technical Area (Basic Understanding)	Management of Technical Area (Meets Expectations)	Management of Technical Area (Exceeded Expectations)	Management of Technical Area (N/A)

Referee Positioning*

Referee Positioning
	Coaching Required (See comments below)	Basic Understanding	Meets Expectations	Exceeds Expectations	N/A
Kick-off	Referee Positioning: Kick-off (Coaching Required (See comments below))	Kick-off (Basic Understanding)	Kick-off (Meets Expectations)	Kick-off (Exceeds Expectations)	Kick-off (N/A)
Corner kicks	Corner kicks (Coaching Required (See comments below))	Corner kicks (Basic Understanding)	Corner kicks (Meets Expectations)	Corner kicks (Exceeds Expectations)	Corner kicks (N/A)
Free Kicks	Free Kicks (Coaching Required (See comments below))	Free Kicks (Basic Understanding)	Free Kicks (Meets Expectations)	Free Kicks (Exceeds Expectations)	Free Kicks (N/A)
Drop zone of ball (e.g. Goalkick drop zones)	Drop zone of ball (e.g. Goalkick drop zones) (Coaching Required (See comments below))	Drop zone of ball (e.g. Goalkick drop zones) (Basic Understanding)	Drop zone of ball (e.g. Goalkick drop zones) (Meets Expectations)	Drop zone of ball (e.g. Goalkick drop zones) (Exceeds Expectations)	Drop zone of ball (e.g. Goalkick drop zones) (N/A)
Anticipation of play	Anticipation of play (Coaching Required (See comments below))	Anticipation of play (Basic Understanding)	Anticipation of play (Meets Expectations)	Anticipation of play (Exceeds Expectations)	Anticipation of play (N/A)
Ball in and around Penalty Area	Ball in and around Penalty Area (Coaching Required (See comments below))	Ball in and around Penalty Area (Basic Understanding)	Ball in and around Penalty Area (Meets Expectations)	Ball in and around Penalty Area (Exceeds Expectations)	Ball in and around Penalty Area (N/A)
Proximity to any incidents	Proximity to any incidents (Coaching Required (See comments below))	Proximity to any incidents (Basic Understanding)	Proximity to any incidents (Meets Expectations)	Proximity to any incidents (Exceeds Expectations)	Proximity to any incidents (N/A)

Referee Coaching point/s*

3 points the referee should work on and solutions/strategies to achieve it.

If the official is under 18 years of age, did they wear the pink armband?

Yes No N/A - Over 18

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Assistant Referee 1

Please complete the below section for the match Assistant Referee 1.

Assistant Referee 1 Teamwork*

Assistant Referee 1 Teamwork
	Coaching Required (See comments below)	Basic Understanding	Meets Expectations	Exceeded Expectations	N/A
Communication (i.e. eye contact, discrete signals)	Assistant Referee 1 Teamwork: Communication (i.e. eye contact, discrete signals) (Coaching Required (See comments below))	Communication (i.e. eye contact, discrete signals) (Basic Understanding)	Communication (i.e. eye contact, discrete signals) (Meets Expectations)	Communication (i.e. eye contact, discrete signals) (Exceeded Expectations)	Communication (i.e. eye contact, discrete signals) (N/A)
Flag Signals	Flag Signals (Coaching Required (See comments below))	Flag Signals (Basic Understanding)	Flag Signals (Meets Expectations)	Flag Signals (Exceeded Expectations)	Flag Signals (N/A)
Substitution/interchange procedure	Substitution/interchange procedure (Coaching Required (See comments below))	Substitution/interchange procedure (Basic Understanding)	Substitution/interchange procedure (Meets Expectations)	Substitution/interchange procedure (Exceeded Expectations)	Substitution/interchange procedure (N/A)
Corner Kicks	Corner Kicks (Coaching Required (See comments below))	Corner Kicks (Basic Understanding)	Corner Kicks (Meets Expectations)	Corner Kicks (Exceeded Expectations)	Corner Kicks (N/A)
Penalty kicks	Penalty kicks (Coaching Required (See comments below))	Penalty kicks (Basic Understanding)	Penalty kicks (Meets Expectations)	Penalty kicks (Exceeded Expectations)	Penalty kicks (N/A)

Assistant Referee 1 LOTG Knowledge and Application*

Assistant Referee 1 LOTG Knowledge and Application
	Coaching Required (See comments below)	Basic Understanding	Meets Expectations	Exceeds Expectations	N/A
Foul Recognition	Assistant Referee 1 LOTG Knowledge and Application: Foul Recognition (Coaching Required (See comments below))	Foul Recognition (Basic Understanding)	Foul Recognition (Meets Expectations)	Foul Recognition (Exceeds Expectations)	Foul Recognition (N/A)
Penalty area incidents	Penalty area incidents (Coaching Required (See comments below))	Penalty area incidents (Basic Understanding)	Penalty area incidents (Meets Expectations)	Penalty area incidents (Exceeds Expectations)	Penalty area incidents (N/A)
Correct application of sanctions	Correct application of sanctions (Coaching Required (See comments below))	Correct application of sanctions (Basic Understanding)	Correct application of sanctions (Meets Expectations)	Correct application of sanctions (Exceeds Expectations)	Correct application of sanctions (N/A)
Correct and consistent application of Offside	Correct and consistent application of Offside (Coaching Required (See comments below))	Correct and consistent application of Offside (Basic Understanding)	Correct and consistent application of Offside (Meets Expectations)	Correct and consistent application of Offside (Exceeds Expectations)	Correct and consistent application of Offside (N/A)
Consistently in line with 2nd Last defender	Consistently in line with 2nd Last defender (Coaching Required (See comments below))	Consistently in line with 2nd Last defender (Basic Understanding)	Consistently in line with 2nd Last defender (Meets Expectations)	Consistently in line with 2nd Last defender (Exceeds Expectations)	Consistently in line with 2nd Last defender (N/A)
Correct and Consistent application of LOGT within technical area	Correct and Consistent application of LOGT within technical area (Coaching Required (See comments below))	Correct and Consistent application of LOGT within technical area (Basic Understanding)	Correct and Consistent application of LOGT within technical area (Meets Expectations)	Correct and Consistent application of LOGT within technical area (Exceeds Expectations)	Correct and Consistent application of LOGT within technical area (N/A)

Assistant Referee 1 Match Management*

Assistant Referee 1 Match Management
	Coaching Required (See comments below)	Basic Understanding	Meets Expectations	Exceeded Expectations	N/A
Effective body language and signals	Assistant Referee 1 Match Management: Effective body language and signals (Coaching Required (See comments below))	Effective body language and signals (Basic Understanding)	Effective body language and signals (Meets Expectations)	Effective body language and signals (Exceeded Expectations)	Effective body language and signals (N/A)
Flag technique	Flag technique (Coaching Required (See comments below))	Flag technique (Basic Understanding)	Flag technique (Meets Expectations)	Flag technique (Exceeded Expectations)	Flag technique (N/A)
Good wait and see technique	Good wait and see technique (Coaching Required (See comments below))	Good wait and see technique (Basic Understanding)	Good wait and see technique (Meets Expectations)	Good wait and see technique (Exceeded Expectations)	Good wait and see technique (N/A)
Offside Signal	Offside Signal (Coaching Required (See comments below))	Offside Signal (Basic Understanding)	Offside Signal (Meets Expectations)	Offside Signal (Exceeded Expectations)	Offside Signal (N/A)
Confidence in decision making	Confidence in decision making (Coaching Required (See comments below))	Confidence in decision making (Basic Understanding)	Confidence in decision making (Meets Expectations)	Confidence in decision making (Exceeded Expectations)	Confidence in decision making (N/A)
Communication with players	Communication with players (Coaching Required (See comments below))	Communication with players (Basic Understanding)	Communication with players (Meets Expectations)	Communication with players (Exceeded Expectations)	Communication with players (N/A)
Restart of play procedure	Restart of play procedure (Coaching Required (See comments below))	Restart of play procedure (Basic Understanding)	Restart of play procedure (Meets Expectations)	Restart of play procedure (Exceeded Expectations)	Restart of play procedure (N/A)
Management of injuries	Management of injuries (Coaching Required (See comments below))	Management of injuries (Basic Understanding)	Management of injuries (Meets Expectations)	Management of injuries (Exceeded Expectations)	Management of injuries (N/A)
Management of Technical Area	Management of Technical Area (Coaching Required (See comments below))	Management of Technical Area (Basic Understanding)	Management of Technical Area (Meets Expectations)	Management of Technical Area (Exceeded Expectations)	Management of Technical Area (N/A)
Management of ceremonial free kick (when applicable)	Management of ceremonial free kick (when applicable) (Coaching Required (See comments below))	Management of ceremonial free kick (when applicable) (Basic Understanding)	Management of ceremonial free kick (when applicable) (Meets Expectations)	Management of ceremonial free kick (when applicable) (Exceeded Expectations)	Management of ceremonial free kick (when applicable) (N/A)

Assistant Referee 1 Coaching point/s*

List area/s that the Assistant Referee 1 should work on and solutions/strategies to achieve it.

If the offical is under 18 years of age, did they wear the pink armband?

Yes No N/A - Over 18

File

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Assistant Referee 2

Please complete the below section for the match Assistant Referee 2.

Assistant Referee 2 Teamwork*

Assistant Referee 2 Teamwork
	Coaching Required (See comments below)	Basic Understanding	Meets Expectations	Exceeded Expectations	N/A
Communication (i.e. eye contact, discrete signals)	Assistant Referee 2 Teamwork: Communication (i.e. eye contact, discrete signals) (Coaching Required (See comments below))	Communication (i.e. eye contact, discrete signals) (Basic Understanding)	Communication (i.e. eye contact, discrete signals) (Meets Expectations)	Communication (i.e. eye contact, discrete signals) (Exceeded Expectations)	Communication (i.e. eye contact, discrete signals) (N/A)
Flag Signals	Flag Signals (Coaching Required (See comments below))	Flag Signals (Basic Understanding)	Flag Signals (Meets Expectations)	Flag Signals (Exceeded Expectations)	Flag Signals (N/A)
Substitution/interchange procedure	Substitution/interchange procedure (Coaching Required (See comments below))	Substitution/interchange procedure (Basic Understanding)	Substitution/interchange procedure (Meets Expectations)	Substitution/interchange procedure (Exceeded Expectations)	Substitution/interchange procedure (N/A)
Corner Kicks	Corner Kicks (Coaching Required (See comments below))	Corner Kicks (Basic Understanding)	Corner Kicks (Meets Expectations)	Corner Kicks (Exceeded Expectations)	Corner Kicks (N/A)
Penalty kicks	Penalty kicks (Coaching Required (See comments below))	Penalty kicks (Basic Understanding)	Penalty kicks (Meets Expectations)	Penalty kicks (Exceeded Expectations)	Penalty kicks (N/A)

Assistant Referee 2 LOTG Knowledge and Application*

Assistant Referee 2 LOTG Knowledge and Application
	Coaching Required (See comments below)	Basic Understanding	Meets Expectations	Exceeds Expectations	N/A
Foul Recognition	Assistant Referee 2 LOTG Knowledge and Application: Foul Recognition (Coaching Required (See comments below))	Foul Recognition (Basic Understanding)	Foul Recognition (Meets Expectations)	Foul Recognition (Exceeds Expectations)	Foul Recognition (N/A)
Penalty area incidents	Penalty area incidents (Coaching Required (See comments below))	Penalty area incidents (Basic Understanding)	Penalty area incidents (Meets Expectations)	Penalty area incidents (Exceeds Expectations)	Penalty area incidents (N/A)
Correct application of sanctions	Correct application of sanctions (Coaching Required (See comments below))	Correct application of sanctions (Basic Understanding)	Correct application of sanctions (Meets Expectations)	Correct application of sanctions (Exceeds Expectations)	Correct application of sanctions (N/A)
Correct and consistent application of Offside	Correct and consistent application of Offside (Coaching Required (See comments below))	Correct and consistent application of Offside (Basic Understanding)	Correct and consistent application of Offside (Meets Expectations)	Correct and consistent application of Offside (Exceeds Expectations)	Correct and consistent application of Offside (N/A)
Consistently in line with 2nd Last defender	Consistently in line with 2nd Last defender (Coaching Required (See comments below))	Consistently in line with 2nd Last defender (Basic Understanding)	Consistently in line with 2nd Last defender (Meets Expectations)	Consistently in line with 2nd Last defender (Exceeds Expectations)	Consistently in line with 2nd Last defender (N/A)
Correct and Consistent application of LOTG within technical area	Correct and Consistent application of LOTG within technical area (Coaching Required (See comments below))	Correct and Consistent application of LOTG within technical area (Basic Understanding)	Correct and Consistent application of LOTG within technical area (Meets Expectations)	Correct and Consistent application of LOTG within technical area (Exceeds Expectations)	Correct and Consistent application of LOTG within technical area (N/A)

Assistant Referee 2 Match Management*

Assistant Referee 2 Match Management
	Coaching Required (See comments below)	Basic Understanding	Meets Expectations	Exceeded Expectations	N/A
Effective body language and signals	Assistant Referee 2 Match Management: Effective body language and signals (Coaching Required (See comments below))	Effective body language and signals (Basic Understanding)	Effective body language and signals (Meets Expectations)	Effective body language and signals (Exceeded Expectations)	Effective body language and signals (N/A)
Flag technique	Flag technique (Coaching Required (See comments below))	Flag technique (Basic Understanding)	Flag technique (Meets Expectations)	Flag technique (Exceeded Expectations)	Flag technique (N/A)
Good wait and see technique	Good wait and see technique (Coaching Required (See comments below))	Good wait and see technique (Basic Understanding)	Good wait and see technique (Meets Expectations)	Good wait and see technique (Exceeded Expectations)	Good wait and see technique (N/A)
Offside Signal	Offside Signal (Coaching Required (See comments below))	Offside Signal (Basic Understanding)	Offside Signal (Meets Expectations)	Offside Signal (Exceeded Expectations)	Offside Signal (N/A)
Confidence in decision making	Confidence in decision making (Coaching Required (See comments below))	Confidence in decision making (Basic Understanding)	Confidence in decision making (Meets Expectations)	Confidence in decision making (Exceeded Expectations)	Confidence in decision making (N/A)
Communication with players	Communication with players (Coaching Required (See comments below))	Communication with players (Basic Understanding)	Communication with players (Meets Expectations)	Communication with players (Exceeded Expectations)	Communication with players (N/A)
Restart of play procedure	Restart of play procedure (Coaching Required (See comments below))	Restart of play procedure (Basic Understanding)	Restart of play procedure (Meets Expectations)	Restart of play procedure (Exceeded Expectations)	Restart of play procedure (N/A)
Management of injuries	Management of injuries (Coaching Required (See comments below))	Management of injuries (Basic Understanding)	Management of injuries (Meets Expectations)	Management of injuries (Exceeded Expectations)	Management of injuries (N/A)
Management of Technical Area	Management of Technical Area (Coaching Required (See comments below))	Management of Technical Area (Basic Understanding)	Management of Technical Area (Meets Expectations)	Management of Technical Area (Exceeded Expectations)	Management of Technical Area (N/A)
Management of ceremonial free kick (when applicable)	Management of ceremonial free kick (when applicable) (Coaching Required (See comments below))	Management of ceremonial free kick (when applicable) (Basic Understanding)	Management of ceremonial free kick (when applicable) (Meets Expectations)	Management of ceremonial free kick (when applicable) (Exceeded Expectations)	Management of ceremonial free kick (when applicable) (N/A)

Assistant Referee 2 Coaching point/s*

List area/s that the Assistant Referee 1 should work on and solutions/strategies to achieve it.

If the offical is under 18 years of age, did they wear the pink armband?

Yes No N/A - Over 18

File

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Level 4 Field Test

Football Queensland Level 4 Field Test Report

During and at the end of the match the Mentor/Assessor should tick off the items observed. When the items have been noted and ticked off and the Referee or Assistant Referee has shown competency. Mentors / Assessors are encouraged to provide 1 or 2 coaching notes. If there are non competencies then the Mentor / Assessor must provide feedback

Match #1 - Date & Time

Match #1 - Competition

e.g. U13 div 1 Boys

Home Team

Away Team

Match #1 - Role of official

Referee Assistant Referee

Match #2 - Date & Time

Match #2 - Competition

e.g. U13 div 1 Boys

Home Team

Away Team

Match #2 - Role of official

Referee Assistant Referee

If the official is under 18 years of age, did they wear the pink armband?

Yes No N/A - Over 18

Additional Coaching Advice*

Need to have a least 2 coaching point in this area.

Field Test Decision*

Competent Requires further games and a retest

Level 4 Field Test Matchday Coach Name*

First Name

Last Name

Futsal Referee 1 Report

Referee 1 - Control of Game*

Referee 1 - Control of Game
	Coaching Required (See comments below)	Basic Understanding	Meets Expectations	Exceeded Expectations	N/A
Correct and consistent Interpretations of law	Referee 1 - Control of Game: Correct and consistent Interpretations of law (Coaching Required (See comments below))	Correct and consistent Interpretations of law (Basic Understanding)	Correct and consistent Interpretations of law (Meets Expectations)	Correct and consistent Interpretations of law (Exceeded Expectations)	Correct and consistent Interpretations of law (N/A)
Recognition of fouls	Recognition of fouls (Coaching Required (See comments below))	Recognition of fouls (Basic Understanding)	Recognition of fouls (Meets Expectations)	Recognition of fouls (Exceeded Expectations)	Recognition of fouls (N/A)
Differentiation between careless, reckless and excessive force	Differentiation between careless, reckless and excessive force (Coaching Required (See comments below))	Differentiation between careless, reckless and excessive force (Basic Understanding)	Differentiation between careless, reckless and excessive force (Meets Expectations)	Differentiation between careless, reckless and excessive force (Exceeded Expectations)	Differentiation between careless, reckless and excessive force (N/A)
Understanding and management of tactical fouls (Including promising attacks and DOGSO)	Understanding and management of tactical fouls (Including promising attacks and DOGSO) (Coaching Required (See comments below))	Understanding and management of tactical fouls (Including promising attacks and DOGSO) (Basic Understanding)	Understanding and management of tactical fouls (Including promising attacks and DOGSO) (Meets Expectations)	Understanding and management of tactical fouls (Including promising attacks and DOGSO) (Exceeded Expectations)	Understanding and management of tactical fouls (Including promising attacks and DOGSO) (N/A)
Management of Dissent	Management of Dissent (Coaching Required (See comments below))	Management of Dissent (Basic Understanding)	Management of Dissent (Meets Expectations)	Management of Dissent (Exceeded Expectations)	Management of Dissent (N/A)
Application of advantage	Application of advantage (Coaching Required (See comments below))	Application of advantage (Basic Understanding)	Application of advantage (Meets Expectations)	Application of advantage (Exceeded Expectations)	Application of advantage (N/A)

Referee 1 - Positioning and Movement*

Referee 1 - Positioning and Movement
	Coaching Required (See comments below)	Basic Understanding	Meets Expectations	Exceeded Expectations	N/A
Lead referee positioning	Referee 1 - Positioning and Movement: Lead referee positioning (Coaching Required (See comments below))	Lead referee positioning (Basic Understanding)	Lead referee positioning (Meets Expectations)	Lead referee positioning (Exceeded Expectations)	Lead referee positioning (N/A)
Trail referee positioning	Trail referee positioning (Coaching Required (See comments below))	Trail referee positioning (Basic Understanding)	Trail referee positioning (Meets Expectations)	Trail referee positioning (Exceeded Expectations)	Trail referee positioning (N/A)
Angle of view	Angle of view (Coaching Required (See comments below))	Angle of view (Basic Understanding)	Angle of view (Meets Expectations)	Angle of view (Exceeded Expectations)	Angle of view (N/A)
Proximity to play	Proximity to play (Coaching Required (See comments below))	Proximity to play (Basic Understanding)	Proximity to play (Meets Expectations)	Proximity to play (Exceeded Expectations)	Proximity to play (N/A)
Movement when ball in play - anticipation, explosive acceleration etc.	Movement when ball in play - anticipation, explosive acceleration etc. (Coaching Required (See comments below))	Movement when ball in play - anticipation, explosive acceleration etc. (Basic Understanding)	Movement when ball in play - anticipation, explosive acceleration etc. (Meets Expectations)	Movement when ball in play - anticipation, explosive acceleration etc. (Exceeded Expectations)	Movement when ball in play - anticipation, explosive acceleration etc. (N/A)
Positioning when ball out of play - set pieces etc.	Positioning when ball out of play - set pieces etc. (Coaching Required (See comments below))	Positioning when ball out of play - set pieces etc. (Basic Understanding)	Positioning when ball out of play - set pieces etc. (Meets Expectations)	Positioning when ball out of play - set pieces etc. (Exceeded Expectations)	Positioning when ball out of play - set pieces etc. (N/A)
General stamina throughout the match	General stamina throughout the match (Coaching Required (See comments below))	General stamina throughout the match (Basic Understanding)	General stamina throughout the match (Meets Expectations)	General stamina throughout the match (Exceeded Expectations)	General stamina throughout the match (N/A)

Referee 1 - Teamwork*

Referee 1 - Teamwork
	Coaching Required (See comments below)	Basic Understanding	Meets Expectations	Exceeded Expectations	N/A
Communication (i.e. eye contact, discrete signals)	Referee 1 - Teamwork: Communication (i.e. eye contact, discrete signals) (Coaching Required (See comments below))	Communication (i.e. eye contact, discrete signals) (Basic Understanding)	Communication (i.e. eye contact, discrete signals) (Meets Expectations)	Communication (i.e. eye contact, discrete signals) (Exceeded Expectations)	Communication (i.e. eye contact, discrete signals) (N/A)
The appropriate official makes the decision (best viewing position)	The appropriate official makes the decision (best viewing position) (Coaching Required (See comments below))	The appropriate official makes the decision (best viewing position) (Basic Understanding)	The appropriate official makes the decision (best viewing position) (Meets Expectations)	The appropriate official makes the decision (best viewing position) (Exceeded Expectations)	The appropriate official makes the decision (best viewing position) (N/A)
Appropriate focus on area of attention	Appropriate focus on area of attention (Coaching Required (See comments below))	Appropriate focus on area of attention (Basic Understanding)	Appropriate focus on area of attention (Meets Expectations)	Appropriate focus on area of attention (Exceeded Expectations)	Appropriate focus on area of attention (N/A)
Recognition of fouls when he/she has a better view than the other referee	Recognition of fouls when he/she has a better view than the other referee (Coaching Required (See comments below))	Recognition of fouls when he/she has a better view than the other referee (Basic Understanding)	Recognition of fouls when he/she has a better view than the other referee (Meets Expectations)	Recognition of fouls when he/she has a better view than the other referee (Exceeded Expectations)	Recognition of fouls when he/she has a better view than the other referee (N/A)
Support for other match officials	Support for other match officials (Coaching Required (See comments below))	Support for other match officials (Basic Understanding)	Support for other match officials (Meets Expectations)	Support for other match officials (Exceeded Expectations)	Support for other match officials (N/A)

Referee 1 - Coaching Point/s*

If the official is under 18 years of age, did they wear the pink armband?

Yes No N/A - Over 18

Futsal Referee 2 Report

Referee 2 Name

First Name

Last Name

Referee 2 Email

Referee 2 - Control of Game*

Referee 2 - Control of Game
	Coaching Required (See comments below)	Basic Understanding	Meets Expectations	Exceeded Expectations	N/A
Correct and consistent Interpretations of law	Referee 2 - Control of Game: Correct and consistent Interpretations of law (Coaching Required (See comments below))	Correct and consistent Interpretations of law (Basic Understanding)	Correct and consistent Interpretations of law (Meets Expectations)	Correct and consistent Interpretations of law (Exceeded Expectations)	Correct and consistent Interpretations of law (N/A)
Recognition of fouls	Recognition of fouls (Coaching Required (See comments below))	Recognition of fouls (Basic Understanding)	Recognition of fouls (Meets Expectations)	Recognition of fouls (Exceeded Expectations)	Recognition of fouls (N/A)
Differentiation between careless, reckless and excessive force	Differentiation between careless, reckless and excessive force (Coaching Required (See comments below))	Differentiation between careless, reckless and excessive force (Basic Understanding)	Differentiation between careless, reckless and excessive force (Meets Expectations)	Differentiation between careless, reckless and excessive force (Exceeded Expectations)	Differentiation between careless, reckless and excessive force (N/A)
Understanding and management of tactical fouls (Including promising attacks and DOGSO)	Understanding and management of tactical fouls (Including promising attacks and DOGSO) (Coaching Required (See comments below))	Understanding and management of tactical fouls (Including promising attacks and DOGSO) (Basic Understanding)	Understanding and management of tactical fouls (Including promising attacks and DOGSO) (Meets Expectations)	Understanding and management of tactical fouls (Including promising attacks and DOGSO) (Exceeded Expectations)	Understanding and management of tactical fouls (Including promising attacks and DOGSO) (N/A)
Management of Dissent	Management of Dissent (Coaching Required (See comments below))	Management of Dissent (Basic Understanding)	Management of Dissent (Meets Expectations)	Management of Dissent (Exceeded Expectations)	Management of Dissent (N/A)
Application of advantage	Application of advantage (Coaching Required (See comments below))	Application of advantage (Basic Understanding)	Application of advantage (Meets Expectations)	Application of advantage (Exceeded Expectations)	Application of advantage (N/A)

Referee 2 - Positioning and Movement*

Referee 2 - Positioning and Movement
	Coaching Required (See comments below)	Basic Understanding	Meets Expectations	Exceeded Expectations	N/A
Lead referee positioning	Referee 2 - Positioning and Movement: Lead referee positioning (Coaching Required (See comments below))	Lead referee positioning (Basic Understanding)	Lead referee positioning (Meets Expectations)	Lead referee positioning (Exceeded Expectations)	Lead referee positioning (N/A)
Trail referee positioning	Trail referee positioning (Coaching Required (See comments below))	Trail referee positioning (Basic Understanding)	Trail referee positioning (Meets Expectations)	Trail referee positioning (Exceeded Expectations)	Trail referee positioning (N/A)
Angle of view	Angle of view (Coaching Required (See comments below))	Angle of view (Basic Understanding)	Angle of view (Meets Expectations)	Angle of view (Exceeded Expectations)	Angle of view (N/A)
Proximity to play	Proximity to play (Coaching Required (See comments below))	Proximity to play (Basic Understanding)	Proximity to play (Meets Expectations)	Proximity to play (Exceeded Expectations)	Proximity to play (N/A)
Movement when ball in play - anticipation, explosive acceleration etc.	Movement when ball in play - anticipation, explosive acceleration etc. (Coaching Required (See comments below))	Movement when ball in play - anticipation, explosive acceleration etc. (Basic Understanding)	Movement when ball in play - anticipation, explosive acceleration etc. (Meets Expectations)	Movement when ball in play - anticipation, explosive acceleration etc. (Exceeded Expectations)	Movement when ball in play - anticipation, explosive acceleration etc. (N/A)
Positioning when ball out of play - set pieces etc.	Positioning when ball out of play - set pieces etc. (Coaching Required (See comments below))	Positioning when ball out of play - set pieces etc. (Basic Understanding)	Positioning when ball out of play - set pieces etc. (Meets Expectations)	Positioning when ball out of play - set pieces etc. (Exceeded Expectations)	Positioning when ball out of play - set pieces etc. (N/A)
General stamina throughout the match	General stamina throughout the match (Coaching Required (See comments below))	General stamina throughout the match (Basic Understanding)	General stamina throughout the match (Meets Expectations)	General stamina throughout the match (Exceeded Expectations)	General stamina throughout the match (N/A)

Referee 2 - Teamwork*

Referee 2 - Teamwork
	Coaching Required (See comments below)	Basic Understanding	Meets Expectations	Exceeded Expectations	N/A
Communication (i.e. eye contact, discrete signals)	Referee 2 - Teamwork: Communication (i.e. eye contact, discrete signals) (Coaching Required (See comments below))	Communication (i.e. eye contact, discrete signals) (Basic Understanding)	Communication (i.e. eye contact, discrete signals) (Meets Expectations)	Communication (i.e. eye contact, discrete signals) (Exceeded Expectations)	Communication (i.e. eye contact, discrete signals) (N/A)
The appropriate official makes the decision (best viewing position)	The appropriate official makes the decision (best viewing position) (Coaching Required (See comments below))	The appropriate official makes the decision (best viewing position) (Basic Understanding)	The appropriate official makes the decision (best viewing position) (Meets Expectations)	The appropriate official makes the decision (best viewing position) (Exceeded Expectations)	The appropriate official makes the decision (best viewing position) (N/A)
Appropriate focus on area of attention	Appropriate focus on area of attention (Coaching Required (See comments below))	Appropriate focus on area of attention (Basic Understanding)	Appropriate focus on area of attention (Meets Expectations)	Appropriate focus on area of attention (Exceeded Expectations)	Appropriate focus on area of attention (N/A)
Recognition of fouls when he/she has a better view than the other referee	Recognition of fouls when he/she has a better view than the other referee (Coaching Required (See comments below))	Recognition of fouls when he/she has a better view than the other referee (Basic Understanding)	Recognition of fouls when he/she has a better view than the other referee (Meets Expectations)	Recognition of fouls when he/she has a better view than the other referee (Exceeded Expectations)	Recognition of fouls when he/she has a better view than the other referee (N/A)
Support for other match officials	Support for other match officials (Coaching Required (See comments below))	Support for other match officials (Basic Understanding)	Support for other match officials (Meets Expectations)	Support for other match officials (Exceeded Expectations)	Support for other match officials (N/A)

Referee 2 - Coaching Point/s*

If the official is under 18 years of age, did they wear the pink armband?

Yes No N/A - Over 18

Was there a Timekeeper/Referee 3 on this game?

Yes No

Futsal Timekeeper/Referee 3 Report

Timekeeper/Referee 3 Name

First Name

Last Name

Timekeeper/Referee 3 Email

Timekeeper/Referee 3 - Coaching areas*

Timekeeper/Referee 3 - Coaching areas
	Coaching Required (See comments below)	Basic Understanding	Meets Expectations	Exceeded Expectations	N/A
Accurate and effective use of score display and timekeeping equipment	Timekeeper/Referee 3 - Coaching areas: Accurate and effective use of score display and timekeeping equipment (Coaching Required (See comments below))	Accurate and effective use of score display and timekeeping equipment (Basic Understanding)	Accurate and effective use of score display and timekeeping equipment (Meets Expectations)	Accurate and effective use of score display and timekeeping equipment (Exceeded Expectations)	Accurate and effective use of score display and timekeeping equipment (N/A)
Assistance in managing substitution processes	Assistance in managing substitution processes (Coaching Required (See comments below))	Assistance in managing substitution processes (Basic Understanding)	Assistance in managing substitution processes (Meets Expectations)	Assistance in managing substitution processes (Exceeded Expectations)	Assistance in managing substitution processes (N/A)
Assistance in managing technical area	Assistance in managing technical area (Coaching Required (See comments below))	Assistance in managing technical area (Basic Understanding)	Assistance in managing technical area (Meets Expectations)	Assistance in managing technical area (Exceeded Expectations)	Assistance in managing technical area (N/A)
Accurate application of Time outs procedure	Accurate application of Time outs procedure (Coaching Required (See comments below))	Accurate application of Time outs procedure (Basic Understanding)	Accurate application of Time outs procedure (Meets Expectations)	Accurate application of Time outs procedure (Exceeded Expectations)	Accurate application of Time outs procedure (N/A)
Support for referee team in regard to on pitch decisions	Support for referee team in regard to on pitch decisions (Coaching Required (See comments below))	Support for referee team in regard to on pitch decisions (Basic Understanding)	Support for referee team in regard to on pitch decisions (Meets Expectations)	Support for referee team in regard to on pitch decisions (Exceeded Expectations)	Support for referee team in regard to on pitch decisions (N/A)
Match record detail	Match record detail (Coaching Required (See comments below))	Match record detail (Basic Understanding)	Match record detail (Meets Expectations)	Match record detail (Exceeded Expectations)	Match record detail (N/A)

Timekeeper/Referee 3 - Coaching Point/s*

If the official is under 18 years of age, did they wear the pink armband?

Yes No N/A - Over 18

Referee Self-Assessment Form

Degree of Match Difficulty*

1 star being easy and 5 being hard.

Ground/Weather Condition

Home Team Disciplinary Sanction (total) YC & RC (incl. sanction codes and the if sin bin was used)

YC = Yellow Card, RC = Red Card

Away Team Disciplinary Sanction (total) YC & RC (incl. sanction codes and if sin bin was used)

YC = Yellow Card, RC = Red Card

Description of your feelings about the match

Fitness Level (Easy = 1-3, Normal = 4-7, Demanding = 8-10)*

Main Strength identified during the match*

Areas needing attention for improvement identified during the match*

Positioning and reading on the field*