<p> 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:</p><p>DATE of GAME E League Game M</p><p>GAME DAY MTH YEAR LOCATION LOCATION – ARENA GAME PLAYED AT A GAME TYPE G</p><p>AGE O F GRP & LVL N GAME DIFFICULTY LEVEL</p><p>ODMHA DISTRICT ODMHA Association if applicable I</p><p>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:</p><p>Officials Supervision Assessment: F</p><p>O </p><p>S A E R A ) 2 (</p><p>H T G N E R T S F</p><p>O </p><p>S A E R A ) 2 ( T N E M E V O R P M I</p><p>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:</p><p>R O S I V R E P U S S T N</p><p>E GAME M RATING</p><p>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 </p>