Referee Feedback Report

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DIRECTIONS: Please fill in as many fields as possible. The more information included in this report, the faster the resolution will be for all parties. Moreover, this form includes text boxes to enter narrative, comments and feedback (copy and paste into these boxes, if needed). When you submit this form, the Colorado Joint Referee Committee will receive an instant email report and the report will be used to improve our officiating.

This form should be used for '2nd Level Feedback', only.  For details on the reporting levels, click here .  This Feedback Report is to be used only for games affiliated with US Soccer or US Youth Soccer and registered affiliated Referees.  Please do not submit reports for unaffiliated games such as High School, College.

Thank you for taking the time to make the Colorado Referee Program even stronger.

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Reporting Person Information:

Name of Reporting Person:	(Required)
Email Address for Reporting Person:	(Required)
Phone Number for Reporting Person:	(###-###-####)

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Game Information:

Home Team		Coach		Score
Home Team Coach's email address
Away Team		Coach		Score
Game Date (mm/dd/yyyy format)		Game Time
Location (Complex/Field/Park)
League		Division
Game Number		Age/Gender	(i.e., U16G)
Referee Name (if known)
Assistant Referee #1 (if known)		(Bench Side)
Assistant Referee #2 (if known)		(Far-Side)

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The Referee:

Observations	Rating
1. Professional appearance?	NOT OBSERVED YES NO
2. Thorough pre-game?	NOT OBSERVED YES NO
3. Worked as a crew/Worked well with assistants?	NOT OBSERVED YES NO
4. Dealt effectively with substitutes?	NOT OBSERVED YES NO
5. Recognized Assistant Referee flags/offside calls?	NOT OBSERVED YES NO
6. Managed the game?	NOT OBSERVED YES NO
7. The referee used advantage/disadvantage principles?	NOT OBSERVED YES NO
8. Common sense/Age of players was considered?	NOT OBSERVED YES NO
9. Demonstrated COURAGE to make a "big call" or big "no call" at the right time?	NOT OBSERVED YES NO

Comments for the Colorado Joint Referee Committee and Performance Description:

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Overall Performance Ratings for the Referee:(Any rating of 0-4 must have a comment in the text box below)

With '0': Low and '10': High, start with your rating at '5' (Acceptable) and rate up or down from there.

Performance Ratings	Rating
1. Consistency throughout the game:	0 1 2 3 4 5 6 7 8 9 10 Not observed
2. Penalized "unsafe" plays:	0 1 2 3 4 5 6 7 8 9 10 Not observed
3. Use of advantage/disadvantage:	0 1 2 3 4 5 6 7 8 9 10 Not observed
4. Talked players out of "minor" violations:	0 1 2 3 4 5 6 7 8 9 10 Not observed
5. Proper estimate of 10 yards:	0 1 2 3 4 5 6 7 8 9 10 Not observed
6. Dealt with encroachment:	0 1 2 3 4 5 6 7 8 9 10 Not observed
7. Handled player dissent in a professional manner:	0 1 2 3 4 5 6 7 8 9 10 Not observed
8. Handled coach dissent in a professional manner:	0 1 2 3 4 5 6 7 8 9 10 Not observed
9. Dealt with time-wasting issues:	0 1 2 3 4 5 6 7 8 9 10 Not observed

Comments on Referee's Performance Ratings: (any rating of 0-4 must have a comment)

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The Assistant Referees:

Questions	Assistant #1 (Team side)	Assistant #2 (Spectator side)
1. Consistently focused on the game at all times?	NOT OBSERVED YES NO	NOT OBSERVED YES NO
2. Kept up with second to last defender?	NOT OBSERVED YES NO	NOT OBSERVED YES NO
3. Assisted referee in control of the game?	NOT OBSERVED YES NO	NOT OBSERVED YES NO
4. Recognized the level/age of the players?	NOT OBSERVED YES NO	NOT OBSERVED YES NO
5. Effectively got the attention of the referee, when needed?	NOT OBSERVED YES NO	NOT OBSERVED YES NO
6. Fair and consistent enforcement of laws?	NOT OBSERVED YES NO	NOT OBSERVED YES NO
7. Correctly ruled on off-side infractions?	NOT OBSERVED YES NO	NOT OBSERVED YES NO
8. Reacted well to unusual situations?	NOT OBSERVED YES NO	NOT OBSERVED YES NO
9. Correctly ruled on line calls?	NOT OBSERVED YES NO	NOT OBSERVED YES NO
10. Maintained control of his/her touchline?	NOT OBSERVED YES NO	NOT OBSERVED YES NO

Overall Comments for the Assistant Referees:

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Original design contributed by K. Kevin Aten (2010)