WFTDA Interleague Game Reporting Form (IGRF)

Section 1. VENUE & ROSTERS (Complete BEFORE the game)

Location:
VENUE NAME CITY ST/PRV GAME #

Tournament/
Multi-Day Event: TOURNAMENT/MULTI-DAY EVENT NAME HOST LEAGUE NAME

Date: Start Time: Suspension: YES | NO

TEAM ROSTERS - List in order of Skater number

HOME TEAM VISITING TEAM
LEAGUE LEAGUE

TEAM TEAM

COLOR COLOR

# of players Skater # Skater Name # of players Skater # Skater Name

1 1
2 2
3 3
4 4
5 5
6 6
7 7
8 8
9 9
10 10
11 11
12 12
13 13
14 14
15 15
16 16
17 17
18 18
19 19
20 20

Form Printed: 11/12/2021

 Section 2. SCORE & PENALTIES (Complete DURING or IMMEDIATELY AFTER game)
HOME TEAM VISITING TEAM
Period 1 Points Penalties Period 1 Points Penalties
Period 2 Points Penalties Period 2 Points Penalties
TOTAL POINTS: PENALTIES: TOTAL POINTS: PENALTIES:
The Official Score in this game required adjustment: Reason for OS adjustment:
Expulsion/Suspension notes: Suspension was served by:
Expulsion: Suspension: YES | NO

Expulsion: Suspension: YES | NO

Expulsion: Suspension: YES | NO

Form Printed: 11/12/2021

 Section 3. VERIFICATION (Complete IMMEDIATELY AFTER game)
Home Team Captain Visiting Team Captain
Skate Name: Skate Name:
Legal Name: Legal Name:

Signature: Signature:
Head Referee Head NSO
Skate Name: Skate Name:
Legal Name: Legal Name:

Signature: Signature:

For Sanctioned games only: The host team follows the timeline and process for submitting required sanctioning data described in
the WFTDA Sanctioning policy The current WFTDA Sanctioning policy may be found at https://wftda.org/sanctioning-policy
IGRF Rev. 190101 © 2019 Women's Flat Track Derby Association (WFTDA)

Form Printed: 11/12/2021

 Section 4. ROSTER OF NON-SKATING OFFICIALS/STAT TRACKERS/SKATING OFFICIALS
Official Role Official Name League Affiliation Certification Level
Head Non-Skating Official
Penalty Tracker
Penalty Wrangler
Inside Whiteboard Operator
Jam Timer
Scorekeeper
Scorekeeper
ScoreBoard Operator
Penalty Box Manager
Penalty Box Timer
Penalty Box Timer
Lineup Tracker
Lineup Tracker
Non-Skating Official Alternate
Period Timer

Head Referee
Inside Pack Referee
Jammer Referee
Jammer Referee
Outside Pack Referee
Outside Pack Referee
Outside Pack Referee
Referee Alternate
Positions may be left blank, and role names can be changed or added based on actual staffing. Head officials' names must stay in their current place.

For Sanctioned games only: The host team follows the timeline and process for submitting required sanctioning data described in the WFTDA Sanctioning policy The current WFTDA
Sanctioning policy may be found at https://wftda.org/sanctioning-policy
IGRF Rev. 190101 © 2019 Women's Flat Track Derby Association (WFTDA)

Form Printed: 11/12/2021

Score ‘Score’ revision 190101
StatsBook © 2008–2019 WFTDA

Home Team 1
Color Date Scorekeeper Jammer Ref

LEAD
LOST

CALL

INJ.
JAM Jammer's Number Trip 2 Trip 3 Trip 4 Trip 5 Trip 6 Trip 7 Trip 8 Trip 9 Trip 10 Jam Total Game Total

NI

PERIOD TOTALS
Score ‘Score’ revision 190101
StatsBook © 2008–2019 WFTDA

Home Team 2
Color Date Scorekeeper Jammer Ref

LEAD
LOST

CALL

INJ.
JAM Jammer's Number Trip 2 Trip 3 Trip 4 Trip 5 Trip 6 Trip 7 Trip 8 Trip 9 Trip 10 Jam Total

NI

PERIOD TOTALS
Score ‘Score’ revision 190101
StatsBook © 2008–2019 WFTDA

Away Team 1
Color Date Scorekeeper Jammer Ref

LEAD
LOST

CALL

INJ.
JAM Jammer's Number Trip 2 Trip 3 Trip 4 Trip 5 Trip 6 Trip 7 Trip 8 Trip 9 Trip 10 Jam Total Game Total

NI

PERIOD TOTALS
Score ‘Score’ revision 190101
StatsBook © 2008–2019 WFTDA

Away Team 2
Color Date Scorekeeper Jammer Ref

LEAD
LOST

CALL

INJ.
JAM Jammer's Number Trip 2 Trip 3 Trip 4 Trip 5 Trip 6 Trip 7 Trip 8 Trip 9 Trip 10 Jam Total

NI

PERIOD TOTALS
Penalties ‘Penalties’ revision 190101
StatsBook © 2008–2019 WFTDA

Home Team Away Team 1

Color Date Penalty Tracker Color
# PENALTY / JAM # FO/EXP TOTAL NOTES # PENALTY / JAM # FO/EXP TOTAL Codes
1 G
2 (Gross)
3 Misconduct
4 Insubordination

5 A
6 High Block
7 B
8 Back Block
9 L
10 Low Block
11 E
12 Leg Block
13 F
14 Forearms
15 H
16 Head Block
17 M
18 Multiplayer
19 C
20 Illegal Contact

21 Early/Late Hit

22 Out of Play Block

23 D
24 Direction

25 Stop Block

26 P
27 Illegal Position

28 Destruction

29 Skating OOB

30 Failure to Reform

31 Failure to Return

32 Failure to Yield

33 X
34 Cut

35 Illegal Re-entry

36 N
37 Interference

38 Delay of Game

I
Illegal Procedure
Non-Skater Expulsions 0 Non-Skater Expulsions 0 Star Pass Violation
TOTAL PENALTIES FOR PERIOD 1: TOTAL PENALTIES FOR PERIOD 1:
/ Interference
Penalties ‘Penalties’ revision 190101
StatsBook © 2008–2019 WFTDA

Home Team Away Team 2

Color Date Penalty Tracker Color
# PENALTY / JAM # FO/EXP TOTAL NOTES # PENALTY / JAM # FO/EXP TOTAL Codes
1 G
2 (Gross)
3 Misconduct
4 Insubordination

5 A
6 High Block
7 B
8 Back Block
9 L
10 Low Block
11 E
12 Leg Block
13 F
14 Forearms
15 H
16 Head Block
17 M
18 Multiplayer
19 C
20 Illegal Contact

21 Early/Late Hit

22 Out of Play Block

23 D
24 Direction

25 Stop Block

26 P
27 Illegal Position

28 Destruction

29 Skating OOB

30 Failure to Reform

31 Failure to Return

32 Failure to Yield

33 X
34 Cut

35 Illegal Re-entry

36 N
37 Interference

38 Delay of Game

I
Illegal Procedure
Non-Skater Expulsions 0 Non-Skater Expulsions 0 Star Pass Violation
TOTAL PENALTIES FOR PERIOD 2: TOTAL PENALTIES FOR PERIOD 2:
/ Interference
 Lineups ‘Lineups’ revision 190101
StatsBook © 2008–2019 WFTDA

Home Team 1
Color Date Lineup Tracker
Jam noPivot Jammer Box Pivot Box Blocker Box Blocker Box Blocker Box Team Roster

– = Entered the box mid-jam. S = Entered between jams or continued from previous jam. | = Finished service. Combined with - and S, creates + and $. 3 = Skater injured or needed sub, sits out 3 jams.
 Lineups ‘Lineups’ revision 190101
StatsBook © 2008–2019 WFTDA

Home Team 2
Color Date Lineup Tracker
Jam noPivot Jammer Box Pivot Box Blocker Box Blocker Box Blocker Box Team Roster

– = Entered the box mid-jam. S = Entered between jams or continued from previous jam. | = Finished service. Combined with - and S, creates + and $. 3 = Skater injured or needed sub, sits out 3 jams.
 Lineups ‘Lineups’ revision 190101
StatsBook © 2008–2019 WFTDA

Away Team 1
Color Date Lineup Tracker
Jam noPivot Jammer Box Pivot Box Blocker Box Blocker Box Blocker Box Team Roster

– = Entered the box mid-jam. S = Entered between jams or continued from previous jam. | = Finished service. Combined with - and S, creates + and $. 3 = Skater injured or needed sub, sits out 3 jams.
 Lineups ‘Lineups’ revision 190101
StatsBook © 2008–2019 WFTDA

Away Team 2
Color Date Lineup Tracker
Jam noPivot Jammer Box Pivot Box Blocker Box Blocker Box Blocker Box Team Roster

– = Entered the box mid-jam. S = Entered between jams or continued from previous jam. | = Finished service. Combined with - and S, creates + and $. 3 = Skater injured or needed sub, sits out 3 jams.
 Penalties-Lineups ‘Penalties-Lineups’ revision 190101
StatsBook © 2008–2019 WFTDA

Home Team 1
Color Date Penalty-Lineup Tracker
Jam noPivot Jammer Box Pivot Box Blocker Box Blocker Box Blocker Box Roster Penalties FO/EXP

Box Codes: – = Entered the box mid-jam. S = Entered between jams or continued from previous jam. Non-Skater
| = Finished service. Combined with - and S, creates + and $. 3 = Skater injured or needed sub, sits out 3 jams. Expulsions
Penalty Codes: G = (Gross) Misconduct/Insub. | A = High Block, B = Back Block, L = Low Block | E = Leg Block,
F = Forearms, H = Head Block, M = Multiplayer | C = Illegal Contact/Early or Late Hit/Out of Play Block,
D = Direction/Stop Block | P = Illegal Position/Destruction/Skating OOB/Failure to Reform/Return/Yield |
X = Cut | N = Interference/Delay of Game | I = Illegal Procedure/Star Pass Violation/Star Pass Interference Total Penalties for Period 1:
 Penalties-Lineups ‘Penalties-Lineups’ revision 190101
StatsBook © 2008–2019 WFTDA

Home Team 2
Color Date Penalty-Lineup Tracker
Jam noPivot Jammer Box Pivot Box Blocker Box Blocker Box Blocker Box Roster Penalties FO/EXP

Box Codes: – = Entered the box mid-jam. S = Entered between jams or continued from previous jam. Non-Skater
| = Finished service. Combined with - and S, creates + and $. 3 = Skater injured or needed sub, sits out 3 jams. Expulsions
Penalty Codes: G = (Gross) Misconduct/Insub. | A = High Block, B = Back Block, L = Low Block | E = Leg Block,
F = Forearms, H = Head Block, M = Multiplayer | C = Illegal Contact/Early or Late Hit/Out of Play Block,
D = Direction/Stop Block | P = Illegal Position/Destruction/Skating OOB/Failure to Reform/Return/Yield |
X = Cut | N = Interference/Delay of Game | I = Illegal Procedure/Star Pass Violation/Star Pass Interference Total Penalties for Period 2:
 Penalties-Lineups ‘Penalties-Lineups’ revision 190101
StatsBook © 2008–2019 WFTDA

Away Team 1
Color Date Penalty-Lineup Tracker
Jam noPivot Jammer Box Pivot Box Blocker Box Blocker Box Blocker Box Roster Penalties FO/EXP

Box Codes: – = Entered the box mid-jam. S = Entered between jams or continued from previous jam. Non-Skater
| = Finished service. Combined with - and S, creates + and $. 3 = Skater injured or needed sub, sits out 3 jams. Expulsions
Penalty Codes: G = (Gross) Misconduct/Insub. | A = High Block, B = Back Block, L = Low Block | E = Leg Block,
F = Forearms, H = Head Block, M = Multiplayer | C = Illegal Contact/Early or Late Hit/Out of Play Block,
D = Direction/Stop Block | P = Illegal Position/Destruction/Skating OOB/Failure to Reform/Return/Yield |
X = Cut | N = Interference/Delay of Game | I = Illegal Procedure/Star Pass Violation/Star Pass Interference Total Penalties for Period 1:
 Penalties-Lineups ‘Penalties-Lineups’ revision 190101
StatsBook © 2008–2019 WFTDA

Away Team 2
Color Date Penalty-Lineup Tracker
Jam noPivot Jammer Box Pivot Box Blocker Box Blocker Box Blocker Box Roster Penalties FO/EXP

Box Codes: – = Entered the box mid-jam. S = Entered between jams or continued from previous jam. Non-Skater
| = Finished service. Combined with - and S, creates + and $. 3 = Skater injured or needed sub, sits out 3 jams. Expulsions
Penalty Codes: G = (Gross) Misconduct/Insub. | A = High Block, B = Back Block, L = Low Block | E = Leg Block,
F = Forearms, H = Head Block, M = Multiplayer | C = Illegal Contact/Early or Late Hit/Out of Play Block,
D = Direction/Stop Block | P = Illegal Position/Destruction/Skating OOB/Failure to Reform/Return/Yield |
X = Cut | N = Interference/Delay of Game | I = Illegal Procedure/Star Pass Violation/Star Pass Interference Total Penalties for Period 2:
WFTDA Expulsion-Suspension Form ‘Expulsion-Suspension Form’ revision 190101
StatsBook © 2008–2019 WFTDA

This form should be completed and signed for any expulsion in a game. Statements are not required and may be continued on the reverse side. All signatures certify receipt of the form and
one's own statement; it does not express agreement with the statement(s) of others. Any party who may, and chooses to, recommend a suspension should check the appropriate box next to
their contact information.
For WFTDA-sanctioned games, the expulsion must be recorded on the IGRF in the appropriate section. Return signed and completed Expulsion/Suspension forms to WFTDA Sanctioning with
the completed StatsBook and signed IGRF. These will be filed with the game documentation. If any party wishes to have an incident reviewed by the Games Review Panel (GRP), indicate this

Game Date: Teams Participating:

Suspension Recommended Below: YES | NO Meeting Results (if held):

Name of Official Witnessing the Action: Signature:

Official's Legal Name: League Affiliation: Penalty Issued:
Official's Contact Information:
Incident:

Head Referee Name: Signature:

Head Referee's Legal Name: League Affiliation: Suspension Recommended:
Head Referee's Contact Information: YES | NO
Comments:

Expelled Skater: Signature:

Skater's Legal Name: League Affiliation:
Skater's Contact Information:
Comments:

Home/Dark Team Captain Name: Signature:

Captain's Legal Name: League Affiliation: Suspension Recommended:

Captain's Contact Information: YES | NO

Comments:

Away/Light Team Captain Name: Signature:

Captain's Legal Name: League Affiliation: Suspension Recommended:

Captain's Contact Information: YES | NO

Comments:

FOR TOURNAMENT PLAY

Tournament Head Referee Name: Signature:

THR's Legal Name: League Affiliation: Suspension Recommended:

THR's Contact Information: YES | NO

Comments:

GTO Name (if present): Signature:

GTO's Legal Name: League Affiliation: Suspension Recommended:

GTO's Contact Information: YES | NO

Comments:
 #
#
ROSTERS

TEAM SUMMARIES
TEAM SUMMARIES

Away Team
Home Team

JAMMER JAMMER

0
0
PIVOT PIVOT

0
0
BLOCKER BLOCKER

0
0
JAMS PLAYED

TOTAL TOTAL

0 -
0 -
%
% JAMS
JA
SKATED
MS

POINTS POINTS

0 -
0 -
PPJ PPJ

LOST LOST

0
0
LEAD LEAD

0
0
CALLED CALLED

0
0
NO INITIAL TRIP NO INITIAL TRIP

0
0 STA
STAR PASSES
R
LEAD JAMMER

RECEIVED
PAS

0 -
0 -

LEAD % LEAD %

LEAD +/- LEAD +/-

0 -
0 -

AVE
AVERAGE LEAD
RA
+/-
GE

-
-

PTS FOR PTS FOR

-
-

PTS AGAINST PTS AGAINST

-
-

TOTAL +/- TOTAL +/-

-
-

JAMMER +/- JAMMER +/-

ENTER DATE ON IGRF TAB!
PLEASE FILL IN THE IGRF TAB!

-
-

AVE
AVERAGE
RA
JAMMER +/-
GE

-
-

PIVOT +/- PIVOT +/-

WFTDA REQUIRED STANDARDIZED STATS

-
-

AVE
AVERAGE PIVOT
RA
+/-
GE

-
-

BLOCK +/- BLOCK +/-

-
-

AVE
AVERAGE
RA
BLOCKER +/-
POINTS FOR/AGAINST & PLUS/MINUS

GE

-
-

PACK +/- PACK +/-

-
-

AVE
AVERAGE
RA
PACK +/-
GE

-
-

AVG +/- AVG +/-

VTA
VTAR PTS FOR R
N/A
N/A

PTS
VTA
VTAR PTS
R
N/A
N/A

AGAINST
PTS
VTA
VTAR TOTAL +/- R
N/A
N/A

TOT
VTA
VTAR JAMMER
R
N/A
N/A

AVG +/-
JA
VTA
VTAR PIVOT
V.T.A.R.

R
N/A
N/A

AVG +/-
PIV
VTA
VTAR BLOCKER
R
N/A
N/A

AVG +/-
BLO
VTA
VTAR PACK
R
N/A
N/A

AVG +/-
PAC
TOT
TOTAL VTAR
AL
N/A
N/A

AVG +/-
VTA
SK
SKATERS AT
0
0

PENALTY ERS
COUNT PE
PENALTIES

NA
 #
Home Team

Enter expelled bench staff name here

Enter expelled bench staff name here
SKATER

PENALTY TOTALS
Misc

0
Misconduct
ond
High

0
High Block
Bloc
Back

0
Back Block
Bloc
Low

0
Low Block
Bloc
Leg

0
Leg Block
Bloc
Fore

0
Forearms

… vs opponent:
Avg Penalties / Jam:
arm
Hea

0
Head Block
d
Mult

0
Multiplayer
iplay
Illeg

0
Illegal Contact
al
Dire

0
Direction
ctio
Penalties by Skaters

Illeg

0
Illegal Position
al

0
Cut Cut
Inter

0
Interference

Team Total Penalties as

% of Game Total:
fere
Illeg
0 Illegal Procedure
al
PENALTIES SUMMARY

TO
0

TOTAL
TAL
Pena
0

lty
Cou

Expu
0

lsion
Total
Expulsions
-

Jams Skated
Total Penalties

Pena
lties
-

of Game Total Penalties

Per
EXTRAPOLATED

Jam
 #
Away Team

Enter expelled bench staff name here

Enter expelled bench staff name here
SKATER

PENALTY TOTALS
0
Misconduct Misconduct

0
High Block High Block

0
Back Block Back Block

0
Low Block Low Block

0
Leg Block Leg Block

0
Forearms Forearms

… vs opponent:
Avg Penalties / Jam:
0
Head Block Head Block

0
Multiplayer Multiplayer

0
Illegal Contact Illegal Contact

0
Direction Direction
Penalties by Skaters

0
Illegal Position Illegal Position

0
Cut Cut

0
Interference Interference

Team Total Penalties as

% of Game Total:
0
Illegal Procedure Illegal Procedure
PENALTIES SUMMARY

0
TOTAL TOTAL

0
Penalty Count
0

Expulsion
Total
Expulsions
-

Jams Skated
Total Penalties
-

Penalties Per Jam

of Game Total Penalties
EXTRAPOLATED
 OS Offset ‘OS Offset’ revision 190101
StatsBook © 2008–2019 WFTDA

Home Team Date 1

Jam Official Score Offset +/- Description

Period
Offset 0
 OS Offset ‘OS Offset’ revision 190101
StatsBook © 2008–2019 WFTDA

Home Team Date 2

Jam Official Score Offset +/- Description

Period
Offset 0
 OS Offset ‘OS Offset’ revision 190101
StatsBook © 2008–2019 WFTDA

Away Team Date 1

Jam Official Score Offset +/- Description

Period
Offset 0
 OS Offset ‘OS Offset’ revision 190101
StatsBook © 2008–2019 WFTDA

Away Team Date 2

Jam Official Score Offset +/- Description

Period
Offset 0
 Official Reviews ‘Official Reviews’ revision 190101
StatsBook © 2008–2019 WFTDA

Home Team
Date Tracked By
Away Team
Period 1
Team: Jam Period Length of Keep
Number: Clock: Review: Review?
YES / NO
Details:
Result:
Team: Jam Period Length of Keep
Number: Clock: Review: Review?
YES / NO
Details:
Result:
Team: Jam Period Length of Keep
Number: Clock: Review: Review?
YES / NO
Details:
Result:
Team: Jam Period Length of Keep
Number: Clock: Review: Review?
YES / NO
Details:
Result:

Total Time Elapsed for

Official Reviews:
 Official Reviews ‘Official Reviews’ revision 190101
StatsBook © 2008–2019 WFTDA

Home Team
Date Tracked By
Away Team
Period 2
Team: Jam Period Length of Keep
Number: Clock: Review: Review?
YES / NO
Details:
Result:
Team: Jam Period Length of Keep
Number: Clock: Review: Review? YES / NO
Details:

Result:

Team: Jam Period Length of Keep

Number: Clock: Review: Review? YES / NO
Details:

Result:

Team: Jam Period Length of Keep

Number: Clock: Review: Review? YES / NO
Details:

Result:

Total Time Elapsed for

Official Reviews:
 Penalty Box ‘Penalty Box’ revision 190101
StatsBook © 2008–2019 WFTDA

Home Team
Color Date Penalty Box Timer
Btwn
Period Jam # Team Skater # Pos In Stand Done Time at End of Jam Jam # Total Penalties
Jams
1 1
2 2
3 3
4 4
5 5
6 6
7 7
8 8
9 9
10 10
11 11
12 12
13 13
14 14
15 15
16 16
17 17
18 18
19 19
20 20

21 21

22 22

23 23

24 24

25 25

26 26

27 27

28 28

29 29

30 30

31 31

32 32

33 33

34 34

35 35

36 36

37 37

38 38
 Penalty Box ‘Penalty Box’ revision 190101
StatsBook © 2008–2019 WFTDA

Home Team
Color Date Penalty Box Timer
Btwn
Period Jam # Team Skater # Pos In Stand Done Time at End of Jam Jam # Total Penalties
Jams
1 1

2 2

3 3

4 4

5 5

6 6

7 7

8 8

9 9

10 10

11 11

12 12

13 13

14 14

15 15

16 16

17 17

18 18

19 19

20 20

21 21

22 22

23 23

24 24

25 25

26 26

27 27

28 28

29 29

30 30

31 31

32 32

33 33

34 34

35 35

36 36

37 37

38 38
 Penalty Box ‘Penalty Box’ revision 190101
StatsBook © 2008–2019 WFTDA

Away Team
Color Date Penalty Box Timer
Btwn
Period Jam # Team Skater # Pos In Stand Done Time at End of Jam Jam # Total Penalties
Jams
1 1
2 2
3 3
4 4
5 5
6 6
7 7
8 8
9 9
10 10
11 11
12 12
13 13
14 14
15 15
16 16
17 17
18 18
19 19
20 20

21 21

22 22

23 23

24 24

25 25

26 26

27 27

28 28

29 29

30 30

31 31

32 32

33 33

34 34

35 35

36 36

37 37

38 38
 Penalty Box ‘Penalty Box’ revision 190101
StatsBook © 2008–2019 WFTDA

Away Team
Color Date Penalty Box Timer
Btwn
Period Jam # Team Skater # Pos In Stand Done Time at End of Jam Jam # Total Penalties
Jams
1 1

2 2

3 3

4 4

5 5

6 6

7 7

8 8

9 9

10 10

11 11

12 12

13 13

14 14

15 15

16 16

17 17

18 18

19 19

20 20

21 21

22 22

23 23

24 24

25 25

26 26

27 27

28 28

29 29

30 30

31 31

32 32

33 33

34 34

35 35

36 36

37 37

38 38
Rosters

Home Team Away Team

Officials

Form Printed: 11/12/2021

Game Clock ‘Game Clock’ revision 190101
StatsBook © 2008–2019 WFTDA

Home: Home Team

1
Away: Away Team Period Timer Date
NAME TIMEOUTS TAKEN REVIEW TEAM
C
Home Team
A
C
Away Team
A

Identify Captains and Alternates before game. Indicate time on period clock when TO or OR used.
JAM JAM TIME PACK LAPS EVENT TEAM/SKATER Laps/Min Pts/Min

Team EVENTs: Record TO for team timeout or OR for official review, and indicate the team color.
Skater EVENTs: Record INJ for jam-ending injury or EXP for expulsion, indicate team color & skater number.
Other EVENTs: Record OFF for any other official timeout.
Game Clock ‘Game Clock’ revision 190101
StatsBook © 2008–2019 WFTDA

Home: Home Team

2
Away: Away Team Period Timer Date
NAME TIMEOUTS TAKEN REVIEW TEAM
C
Home Team
A

C
Away Team
A
Identify Captains and Alternates before game. Indicate time on period clock when TO or OR used.
JAM JAM TIME PACK LAPS EVENT TEAM/SKATER Laps/Min Pts/Min

Team EVENTs: Record TO for team timeout or OR for official review, and indicate the team color.
Skater EVENTs: Record INJ for jam-ending injury or EXP for expulsion, indicate team color & skater number.
Other EVENTs: Record OFF for any other official timeout.
 P1 Points: P1 Penalties: P1 Points: P1 Penalties:
Head NSO: P2 Points: P2 Penalties: P2 Points: P2 Penalties:
Head Ref: Total Points: Total Penalties: Total Points: Total Penalties:
Name Position Notes
Head Non-Skating
Official Tracker
Penalty
Penalty Wrangler
Inside Whiteboard
Operator
Jam Timer
Scorekeeper
Scorekeeper
ScoreBoard Operator
Penalty Box Manager
Penalty Box Timer
Penalty Box Timer
Lineup Tracker
Lineup Tracker
Non-Skating Official
Alternate
Period Timer
Overall:
 P1 Points: P1 Penalties: P1 Points: P1 Penalties:
Head NSO: P2 Points: P2 Penalties: P2 Points: P2 Penalties:
Head Ref: Total Points: Total Penalties: Total Points: Total Penalties:
Name Position Notes
Head Referee
Inside Pack Referee
Jammer Referee
Jammer Referee
Outside Pack Referee
Outside Pack Referee
Outside Pack Referee
Referee Alternate
Overall:
 Logo

Head NSO:
Head Ref:

Score Penalties Score Penalties

Period 1
Period 2
Total

Jersey Color
Helmet Cover
Captain
Designated Alt
# of Bench Staff
Starting Bench Jammer Line Pivot Line Jammer Line Pivot Line
Roster Notes

□ Final game rosters submitted:

□
□
□ IGRF signed
Y / N Expulsion
Y / N Official Score Adjustment
□ Score and IGRF Submitted
□ Official Review Form Submitted
□ Expulsion Form Submitted
□ StatsBook Data Entered
□ StatsBook Submitted
 Period 1
Total Jams 0
Home Team Lead 0
Home Team Skaters 0

Skater Summary
0 Sk # Sk Name Pivot % Pivot Blocker Blocker Blocker Blocker
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20

Skater: +/-
0 Sk # Sk Name Pivot Blocker Blocker Blocker Blocker
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20

Skater: Points For

0 Sk # Sk Name Pivot Blocker Blocker Blocker Blocker
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20

Skater: Points Against

0 Sk # Sk Name Pivot Blocker Blocker Blocker Blocker
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
 Period 2
Total Jams 0
Home Team Lead 0
Home Team Skaters 0

Skater Summary
0 Sk # Sk Name Pivot % Pivot Blocker Blocker Blocker Blocker
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20

Skater: +/-
0 Sk # Sk Name Pivot Blocker Blocker Blocker Blocker
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20

Skater: Points For

0 Sk # Sk Name Pivot Blocker Blocker Blocker Blocker
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20

Skater: Points Against

0 Sk # Sk Name Pivot Blocker Blocker Blocker Blocker
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Total B % Total B Pack % Pack Lead Jammer % Jammer Total % Total

Total B Pack Lead Jammer Total

Total B Pack Lead Jammer Total

Total B Pack Lead Jammer Total

Total B % Total B Pack % Pack Lead Jammer % Jammer Total % Total

Total B Pack Lead Jammer Total

Total B Pack Lead Jammer Total

Total B Pack Lead Jammer Total

 Period 1
Total Jams 0
Away Team Lead 0
Away Team Skaters 0

Skater Summary
0 Sk # Sk Name Pivot % Pivot Blocker Blocker Blocker Blocker
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20

Skater: +/-
0 Sk # Sk Name Pivot Blocker Blocker Blocker Blocker
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20

Skater: Points For

0 Sk # Sk Name Pivot Blocker Blocker Blocker Blocker
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20

Skater: Points Against

0 Sk # Sk Name Pivot Blocker Blocker Blocker Blocker
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
 Period 2
Total Jams 0
Away Team Lead 0
Away Team Skaters 0

Skater Summary
0 Sk # Sk Name Pivot % Pivot Blocker Blocker Blocker Blocker
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20

Skater: +/-
0 Sk # Sk Name Pivot Blocker Blocker Blocker Blocker
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20

Skater: Points For

0 Sk # Sk Name Pivot Blocker Blocker Blocker Blocker
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20

Skater: Points Against

0 Sk # Sk Name Pivot Blocker Blocker Blocker Blocker
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Total B % Total B Pack % Pack Lead Jammer % Jammer Total % Total

Total B Pack Lead Jammer Total

Total B Pack Lead Jammer Total

Total B Pack Lead Jammer Total

Total B % Total B Pack % Pack Lead Jammer % Jammer Total % Total

Total B Pack Lead Jammer Total

Total B Pack Lead Jammer Total

0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0

Total B Pack Lead Jammer Total

0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
 Penalties by Skaters Pen FO/Expel
Home Sk # Sk Name G A B L E F H M C D P X N I Total Min FO G A B L E F H M C D P N

Per 1
1
Per 2
Per 1
2
Per 2
Per 1
3
Per 2
Per 1
4
Per 2
Per 1
5
Per 2
Per 1
6
Per 2
Per 1
7
Per 2
Per 1
8
Per 2
Per 1
9
Per 2
Per 1
10
Per 2

11 Per 1
Per 2
Per 1
12
Per 2
Per 1
13
Per 2
Per 1
14
Per 2
Per 1
15
Per 2
Per 1
16
Per 2
Per 1
17
Per 2
Per 1
18
Per 2
Per 1
19
Per 2
Per 1
20
Per 2
Per 1
Non Skater Expulsions
Per 2
Per 1
Non Skater Expulsions
Per 2
Per 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Home Totals Per 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
 Penalties by Skaters Pen FO/Expel
Away Sk # Sk Name G A B L E F H M C D P X N I Total Min FO G A B L E F H M C D P N
Per 1
1
Per 2
Per 1
2
Per 2
Per 1
3
Per 2
Per 1
4
Per 2
Per 1
5
Per 2
Per 1
6
Per 2
Per 1
7
Per 2
Per 1
8
Per 2
Per 1
9
Per 2
Per 1
10
Per 2
Per 1
11
Per 2
Per 1
12
Per 2
Per 1
13
Per 2
Per 1
14
Per 2
Per 1
15
Per 2
Per 1
16
Per 2
Per 1
17
Per 2
Per 1
18
Per 2
Per 1
19
Per 2
Per 1
20
Per 2
Per 1
Non Skater Expulsions
Per 2
Per 1
Non Skater Expulsions
Per 2
Per 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Away Totals Per 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
 Per 1 Home 2 17 3 4 5 6 7 19 2
Jam # Jam Row Jammer Points Team Pts +/- Lost Lead Lead +/- Call Inj NI Trips Time Pts / Min
1

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

29

30

31

32

33

34

35

36

37

38

0 0 0 0 Avg:
Per 1 Total 0 0
0
 Per 2 Home
Jam # Jam Row Jammer Points Team Pts +/- Lost Lead Lead +/- Call Inj NI Trips Time Pts / Min
1

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

29

30

31

32

33

34

35

36

37

38

0 0 0 0 Avg:
Per 2 Total 0 0
0
Home Jammer Points Jams +/- Lost Lead Lead +/- Call Inj NI Trips
1 Per 1
Per 2
Total
2 Per 1
Per 2
Total
3 Per 1
Per 2
Total
4 Per 1
Per 2
Total
5 Per 1
Per 2
Total
6 Per 1
Per 2
Total
7 Per 1
Per 2
Total
8 Per 1
Per 2
Total
9 Per 1
Per 2
Total
10 Per 1
Per 2
Total
11 Per 1
Per 2
Total
12 Per 1
Per 2
Total
13 Per 1
Per 2
Total
14 Per 1
Per 2
Total
15 Per 1
Per 2
Total
16 Per 1
Per 2
Total
17 Per 1
Per 2
Total
18 Per 1
Per 2
Total
19 Per 1
Per 2
Total
20 Per 1
Per 2
Total
 Per 1 Away 21 36 22 23 24 25 26 38
Jam # Jam Row Jammer Points Team Pts +/- Lost Lead Lead +/- Call Inj NI Trips Time Pts / Min
1

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

29

30

31

32

33

34

35

36

37

38

0 0 0 0 Avg:
Per 1 Total 0 0
0
 Per 2 Away
Jam # Jam Row Jammer Points Team Pts +/- Lost Lead Lead +/- Call Inj NI Trips Time Pts / Min
1

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

29

30

31

32

33

34

35

36

37

38

0 0 0 0 Avg:
Per 2 Total 0 0
0
Away Jammer Points Jams +/- Lost Lead Lead +/- Call Inj NI Trips
1 Per 1
Per 2
Total
2 Per 1
Per 2
Total
3 Per 1
Per 2
Total
4 Per 1
Per 2
Total
5 Per 1
Per 2
Total
6 Per 1
Per 2
Total
7 Per 1
Per 2
Total
8 Per 1
Per 2
Total
9 Per 1
Per 2
Total
10 Per 1
Per 2
Total
11 Per 1
Per 2
Total
12 Per 1
Per 2
Total
13 Per 1
Per 2
Total
14 Per 1
Per 2
Total
15 Per 1
Per 2
Total
16 Per 1
Per 2
Total
17 Per 1
Per 2
Total
18 Per 1
Per 2
Total
19 Per 1
Per 2
Total
20 Per 1
Per 2
Total