Competition

Home Team

Away Team

Venue

Date

Time

Players Name & No

Caution Offence Select OneN/AY1 Unsporting Behaviour - Late tackleY2 Unsporting Behaviour - Reckless tackleY3 Unsporting Behaviour - Foul tackle from behindY4 Unsporting Behaviour - Deliberate and blatant trippingY5 Unsporting Behaviour - Deliberate and blatant handballY6 Unsporting Behaviour - Blatant holding an opponentY7 Unsporting Behaviour - Heavy body chargeY8 Unsporting Behaviour - Jumping at an opponentY9 Unsporting Behaviour - Pushing an opponentY10 Unsporting Behaviour - Elbowing an opponentY11 Unsporting Behaviour – Breaking up a promising opposition attackY12 Encroachment when play is restarted with a free kick corner kick or throw-inY13 Shows dissent by wordY14 Shows dissent by gestureY15 Persistently infringing the Laws of the GameY16 Delaying the restart of playY17 Making unsporting remarks or gesturesY18 Entering the field of play without the referee’s permissionY19 Leaving the field of play without the referee’s permissionY20 Unsporting Behaviour - Blatant divingY21 Unsporting Behaviour - Feigning injuryY22 Removing the shirt to celebrate scoring a goalY23 Conduct warranting a caution not previously specifiedY24 Unsporting behaviour by a substituteY25 Dissent by a substituteY26 Delaying the restart of play by a substituteY27 Provoking a confrontation by deliberately touching the ball after

Players Club

SECOND CAUTION OFFENCES ONLY

Time2

2nd Caution Offence N/AY1 Unsporting Behaviour - Late tackleY2 Unsporting Behaviour - Reckless tackleY3 Unsporting Behaviour - Foul tackle from behindY4 Unsporting Behaviour - Deliberate and blatant trippingY5 Unsporting Behaviour - Deliberate and blatant handballY6 Unsporting Behaviour - Blatant holding an opponentY7 Unsporting Behaviour - Heavy body chargeY8 Unsporting Behaviour - Jumping at an opponentY9 Unsporting Behaviour - Pushing an opponentY10 Unsporting Behaviour - Elbowing an opponentY11 Unsporting Behaviour – Breaking up a promising opposition attackY12 Encroachment when play is restarted with a free kick corner kick or throw-inY13 Shows dissent by wordY14 Shows dissent by gestureY15 Persistently infringing the Laws of the GameY16 Delaying the restart of playY17 Making unsporting remarks or gesturesY18 Entering the field of play without the referee’s permissionY19 Leaving the field of play without the referee’s permissionY20 Unsporting Behaviour - Blatant divingY21 Unsporting Behaviour - Feigning injuryY22 Removing the shirt to celebrate scoring a goalY23 Conduct warranting a caution not previously specifiedY24 Unsporting behaviour by a substituteY25 Dissent by a substituteY26 Delaying the restart of play by a substituteY27 Provoking a confrontation by deliberately touching the ball after

SEND OFF OFFENCES

Time

Send Off Offence Select OneN/AR1 Serious Foul Play - Striking an opponentR2 Serious Foul Play - Kicking an opponentR3 Serious Foul Play - Elbowing an opponentR4 Spitting at an opponentR5 Law 12 Offence Denying an obvious goal scoring pportunityR6 Handball Offence Denying an obvious goal or goal scoring opportunityR7 Serious Foul Play - A tackle which endangers the safety of an opponentR8 Offensive insulting abusive languageR9 Offensive insulting abusive gesturesR10 Second cautionR11 Behaving in an irresponsible mannerR12 Violent ConductR13 Commits a sending off offence having been sent offR14 Offensive insulting abusive language and/or gestures against a match officialR15 Violent Conduct – Assault of a Match OfficialR16 Send-off not previously specified

Explanation

Referee Name

Referee Number

Email Address

TO BE COMPLETED BY NELSON BAYS FOOTBALL

a) Suspension days this offence

b) Exceptional Misconduct

Judiciary Officer’s Comments

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