Official Supervised Information

OTTAWA DISTRICT HOCKEY ASSOCIATION ** OTTAWA DISTRICT MINOR HOCKEY ASSOCIATION SUPERVISION FORM Official Supervised Information: ODHA# DST Dist 1 First NAME Last Name EMAIL CHA Level HC - Lvl I Ref/Line REFEREE - 3 Man System Game Supervised Information:

DATE of GAME E League Game M

GAME DAY MTH YEAR LOCATION LOCATION – ARENA GAME PLAYED AT A GAME TYPE G

AGE O F GRP & LVL N GAME DIFFICULTY LEVEL

ODMHA DISTRICT ODMHA Association if applicable I

TEA COLOUR TEAM NAME SCORE 1 2 3 O F PENALTY 1 2 3 O F M Home Home HM Score Penalties Visitor Visitor VIS Score Penalties Other Officials Working This Game:

Officials Supervision Assessment: F

S A E R A ) 2 (

H T G N E R T S F

S A E R A ) 2 ( T N E M E V O R P M I

Officials Evaluation Scale: ** NI=Needs Improvement ** S=Satisfactory ** VG=Very Good Check appropriate Box NI requires a written explanation OVERALL CATEGORIES NI S VG COMMENTS REFEREE CATEGORIES NI S VG COMMENTS Rule Knowledge Feel for the Game 1 CHA Rules Emphasis (Penalty Selection) 2 Appearance & Presence 3 Fitness Judgement, Consistency & 1 Skating – Forward & Agility Standard 2 Skating – Backward 3 Positioning OTHER: Procedures LINESMAN CATEGORIES NI S VG COMMENTS Signals Teamwork/Awareness 1 Reaction to Pressure 2 Rapport & Communication 3 EFFORT Judgement 1 Attitude (Off-Ice) 2 OTHER: 3 Face-Offs OTHER: Supervisor Comments & Information:

R O S I V R E P U S S T N

E GAME M RATING

M HEIGHT Ft In WEIGHT lbs Poor Needs Imp Satisfactory Very Good Outstanding O C SUPERVISOR PHONE ODHA or SIGNATURE SPRVSR# # Print Name TITLE EMAIL