SASKATCHEWAN HOCKEY ASSOCIATION
          OFFICIALS GAME REPORT / FAX REPORT

Official Making Report
Name:_____________________ Telephone: (h)_______________ (b)_______________

Sign:_________________________ Date:_______________

Name of Offender:_______________ Team & Number:_______________

Game Played at:_______________ Date:_______________

Home Team:_______________ Visiting Team:_______________

Division:  __Minor  __Senior  __Adult Recreation  __Junior  __Female

Classification: (Midget, Bantam, Pee Wee, etc.)______________

Category: (AAA, AA, A, B, C, Tier II, Recreation, etc.)_______________

League:_______________

Type of Game:  __Exhibition  __Tournament  __S.H.A. Playoff  __League

Time of Penalty:_______________ Period:_______________

Penalty:_______________ Rule:_______________

Referee:_______________ Linesmen:_______________ & _______________

Description of Incident: (Explain in detail what took place prior to, at the time and following the incident.)
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To report to S.H.A. fax report and game sheet to Fax # 1-306-789-2450 by noon the following day.

To report to League President:
            Name:_______________
            Address:_______________
            Phone:_______________
by noon the following day and mail report within 24 hours.

For Rules 71 and 80 involving an official, copies of the Game Sheet and Officials Report are to be mailed or faxed to the S.H.A. Referee-in-Chief.