U.S. FIGURE SKATING
REFEREE'S REPORT — NONQUALIFYING COMPETITIONS
TO: U.S. Figure Skating Headquarters (attn: Director of Technical Services)
Singles, Pairs and Dance Competitions: Regional Vice Chair, Competitions Committee
Synchronized Skating Competitions: Sectional Synchronized Skating Vice Chair, Competitions Committee
Following is the Referee's Report covering the following competition:
NAME OF COMPETITION:
PLACE:
DATES:
Please print your name:
Signature:
Date Signed:
1. Did this competition have Solo Dance Series Events?
Yes
No
2. Did this competition have Showcase/Artistic Events?
Yes
No
ITEMS TO BE SUBMITTED
1. Officials’ assignment sheet (Form 104) [rule 1214].
2. A record of the initial and final placements in each event [rule 1214]
(This can be a marked copy of the competition program, copies of signed Hal2 computer
component/cumulative results (or signed copies of Forms 105/105x), or a computer generated summary
of placements).
GENERAL
1. Any deviations from or comments on the following [rule 1214]
[a]
Rules governing competitions:
[b]
The official schedule
[c]
Proper conduct of judges/officials
Note: Cite official’s name and the location, time and specific details of incident(s). Details to be kept
confidential and shared only with those responsible for determining follow up action.
[i]
Code of conduct or code of ethics violations
[ii]
Social media policy violations
(Rev 12/28/2015)
U.S. Figure Skating, 20 First Street, Colorado Springs, CO 80906 ∗ Fax: 719.635.9548 ∗ E-mail: refreport@usfigureskating.org
U.S. FIGURE SKATING
REFEREE'S REPORT — NONQUALIFYING COMPETITIONS
2. Any adverse comments or particularly favorable comments on [rule 1214]
[a]
Rink conditions
[b]
Housing
[c]
Transportation
[d]
Music
[e]
Mini System / IJS Equipment
3. Any protests, accidents, or unusual happenings [rule 1214]
Note: Any significant accidents must also be reported to the Sports Medicine Committee [Rule 1214 (A)(4)].
USE ADDITIONAL SHEETS IF NECESSARY
(Rev 12/28/2015)
U.S. Figure Skating, 20 First Street, Colorado Springs, CO 80906 ∗ Fax: 719.635.9548 ∗ E-mail: refreport@usfigureskating.org
U.S. Figure Skating
Referee Report
List of Judges to Receive CEU Credit
List of Technical Panel Officials to Receive Activity
General Instructions: Please provide the officials’ full names (first and last) as they appear in the U.S. Figure Skating
Directory (no nicknames, and please do not just list the first initial and the last name). Membership numbers are also
available in the U.S. Figure Skating Directory and are greatly appreciated. The more detail that you provide, the better
chance we have of giving the CEU credit/activity to the correct officials.
Name of Competition:
Sanction #:
Referee Name:
Competition Dates:
Below, please list the names of all officials who should receive CEUs for serving as a Judge and/or Referee at this
competition. For CEU guidelines, please visit http://www.usfigureskating.org/content/JudgeCommCEUGuide.pdf.
U.S. Figure Skating #
Judges & Referees
Discipline(s) for Credit
+
Place an x in the appropriate column(s)
S&P
Dance
SYS
First & Last Name
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
+
Disciplines:
S&P = Singles & Pairs
Dance = Ice Dance
SYS = Synchronized Skating
USE ADDITIONAL SHEETS IF NECESSARY
(Rev 12/28/2015)
U.S. Figure Skating, 20 First Street, Colorado Springs, CO 80906 ∗ Fax: 719.635.9548 ∗ E-mail: refreport@usfigureskating.org
U.S. Figure Skating
Referee Report
List of Judges to Receive CEU Credit
List of Technical Panel Officials to Receive Activity
Below, please list the names of all officials who should receive activity for serving as a Technical Controller, Technical
Specialist, Data Operator and/or Video Replay Operator at this competition. If an official served on a technical panel
for more than one discipline, please list that person for each discipline served.
Technical Panel - SINGLES
U.S. Figure Skating #
Role* (Place an x in the appropriate column(s))
TC
TS
Data
Video
U.S. Figure Skating #
Role* (Place an x in the appropriate column(s))
TC
TS
Data
Video
U.S. Figure Skating #
Role* (Place an x in the appropriate column(s))
TC
TS
Data
Video
U.S. Figure Skating #
Role* (Place an x in the appropriate column(s))
TC
TS
Data
Video
First & Last Name
1
2
3
4
5
6
7
8
9
10
Technical Panel - PAIRS
First & Last Name
1
2
3
4
5
Technical Panel - DANCE
First & Last Name
1
2
3
4
5
Technical Panel - SYNCHRONIZED
First & Last Name
1
2
3
4
5
*Role: TC = Controller
TS = Specialist or Assistant
Data = Data Operator
Video = Video Replay Operator
USE ADDITIONAL SHEETS IF NECESSARY
(Rev 12/28/2015)
U.S. Figure Skating, 20 First Street, Colorado Springs, CO 80906 ∗ Fax: 719.635.9548 ∗ E-mail: refreport@usfigureskating.org