Although the information on this form will be emailed to you and to the liaison, it is not a substitute for calling the liaison. In the event of an ejection, you must call him.

EJECTION/INCIDENT REPORT

NAME OF SPORT:                Baseball Softball Football Basketball             DATE OF GAME: Select Month January February March April May June July August September October November December Select Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 , 2010 2011 2012

LEVEL: Varsity Junior Varsity Frosh/Soph     Boys Girls   VISITING SCHOOL:               

                                                           HOME SCHOOL:               

POSITION YOU
WERE WORKING: Select Position Plate Base First Base Third Base Referee Umpire Linesman Line Judge Back Judge U1 U2          PARTNER’S NAME(s):               

SCORE AT TIME       VISITORS                                   WHEN EJECTION
OF EJECTION:           HOME                                          TOOK PLACE:                 

FINAL SCORE:           VISITORS                               HOW LONG WAS
                                     HOME                      GAME DELAYED:                

NAME AND SCHOOL OF PERSON EJECTED (if coach, indicate head or assistant):

WHAT LED TO THE EJECTION?
(Check all that apply.)

 RULING:          BOOK                          CIF-SS RULE                         JUDGMENT

REASON FOR THE EJECTION
(Check all that apply.)
 

LANGUAGE:  PROFANITY     ABUSIVE     PERSONAL     HECKLING

PHYSICAL
CONTACT:     BUMPING     PUSHING     KICKING     STRIKING     FIGHTING

ACTION WAS
AGAINST:       UMPIRE      OPPONENT      SPECTATOR      TEAMMATE

Briefly Describe Incident

Had the ejected person been warned before (circle one)?  yes no

Your name   

Email address               

Work Phone Number                

Home Phone Number                

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