EmailMe Form - REFEREE ABUSE REPORTING FORM

REFEREE ABUSE REPORTING FORM

OSA takes the U.S. Soccer Referee Abuse Prevention Policy (RAP) seriously regarding referee assault, abuse and/or gross misconduct to protect referees and to make our sport safer.

Non-Physical Offenses: include verbal taunting, harassment/intimidation, and offensive or discriminatory acts

Physical Offenses: include minor touching, intentional confrontation, and violent contact

U.S. Soccer and OSA encourages you to do your part in sharing this information and by formally reporting referee abuse so that it can be promptly addressed.

When reporting, please be sure to include match details and all relevant information requested. This Reporting Form shall be utilized in order to report to OSA any cases of suspected referee assault, abuse, and/or gross misconduct that took place in an OSA sanctioned activity.

Involved Individuals Information
Please list any individuals involved, along with any other known details you can provide about each individual.

"Related Information" may include the individual's Date of Birth, Affiliated Club/League, Position/Title/Role, or Contact Information (email address and/or phone number).
Individual #1: Name *
First Last
Individual #1: Related Information *
Individual #2: Name
First Last
Individual #2: Related Information
Individual #3: Name
First Last
Individual #3: Related Information
Individual #4: Name
First Last
Individual #4: Related Information
Individual #5: Name
First Last
Individual #5: Related Information
NOTE: If more than five (5) individuals are involved, please include information regarding additional individuals in the description box below.

Please provide a detailed description of the incident/concern using specific, concise, and objective language (who, what, where, when, why, how).
Incident Description *
Supporting Documentation

Add File

Include any supporting documentation (such as photos, video, etc) to accompany your submitted report.
Acknowledgement *

By checking this box and submitting this form on the next page, I hereby certify that the information I have provided on this Referee Abuse Reporting Form is true and accurate to the best of my knowledge.
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