REFEREE/GAME EVALUATION
Team coach or Manager completes this form after each game and mails to one of the following:

East
Joel Charpentier
407 Park Ave
Chesterton, IN 46304

 West
Mo Tolimir
218 Barbara Jean Dr.
Schererville, IN 46375		 Men/Women
Luigi Boria
6633 Colorado
Hammond, IN 46323
Game Date: _____________________ Location: _____________________ Age Group: ________
Home Team: ________________________________ Visiting Team: _____________________________
Final Score:
Home: ________ Visitor: ________
Referee: ______________________________________
Assistants (sub side): ____________________________ (spectator side): ___________________________
Individual completing form: ___________________________________________ Affiliation: Home/Visitor
 
Excellent
Very Good
Good
Fair
Poor

1. DRESS & APPEARANCE
Correct Uniform, Badge, etc.
5
4
3
2
1
2. PRE-GAME ORGANIZATION
On time, inspection of the field, players' equipment and cards.
5
4
3
2
1
3. FITNESS
Position on field during play, works effectively with assistants if present.
5
4
3
2
1
4. ATTITUDE
Toward players, coaches, spectators and other officials.
5
4
3
2
1
5. GAME CONTROL
Overall was in charge of the match.
5
4
3
2
1
6. SIGNALS
Clear, understandable.
5
4
3
2
1
7. ACCURACY OF DECISIONS
Impartiality, consistency.
5
4
3
2
1
8. ASSISTANT #1 (Team Side)
5
4
3
2
1
9. ASSISTANT #2 (Spectators)
5
4
3
2
1
10. Would you have these officials referee your games in the future?
Referee
Yes/No
Assistant #1
Yes/No
Assistant #2
Yes/No
Use the back for additional comments...........