Hockey Officials Penalty Incident Report – Alaska School Activities Association

Whenever a team accumulates fifteen (15) penalties in one game, or is assessed a GAME MISCONDUCT, GAME DISQUALIFICATION, and/or GAME SUSPENSION penalty in any Alaska High School hockey game, the game referee must fill out and submit this report within 24 hours.

Date of Game*
MM slash DD slash YYYY
Game Location*

Facility and City
Home School*
Visiting School*
Type of Violation*
Offending School (if 15 penalties)
Offending Individual #1
If player: list jersey number, name, school, penalty. If non-player: list name, school, penalty. Include all facts pertaining to penalty and rule book reference.
Offending Individual #2
If player: list jersey number, name, school, penalty. If non-player: list name, school, penalty. Include all facts pertaining to penalty and rule book reference.
Offending Individual #3
If player: list jersey number, name, school, penalty. If non-player: list name, school, penalty. Include all facts pertaining to penalty and rule book reference.
Reporting Official's Name*
First Last
Reporting Official's Phone*
Reporting Official's Email
Date of Report*
MM slash DD slash YYYY

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