Referee’s Assessment
of Coaches’ Game Behavior
Your ratings and comments will be kept confidential unless you mark “may be shared” at the end of this form. If you mark "may", your comments will be passed on to the coach, coach's club, league, and/or district. Even if this assessment is shared, your name, phone number, and email address will NOT be revealed.

Game date Scheduled Kick-off Time  

City Field

Age group Pull down to select U6 U7 U8 U9 U10 U11 U12 U13 U14 U15 U16 U17 U18 U19 Boys/Girls Pull down to select Boys Girls Class Pull down to select Recreational - Class 4 Competitive - Class 3 Competitive - Class 1 Competitive - Premier  

Home club and team Visiting club and team

Are you reporting on the behavior of the  home team or  visiting team?

Team staff names, if known: 

Please rate the team staff using the scale of 5 (outstanding) to 1 (unsatisfactory). You don't have to fill in everything if you are just commenting on specific characteristics.  
                                                                     5                4             3            2              1
                                                          Outstanding    Good   Average Poor Unsatisfactory 
                                                                                                      

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