Provide complete identification details for the tournament match during which the incident occurred. All fields marked as mandatory must be filled to ensure proper tracking and resolution.
Tournament Official Name
Tournament Phase
Group Stage
Swiss Stage
Knockout Stage
Quarter-Finals
Semi-Finals
Grand Finals
Qualifiers
Playoffs
Unique Match Identification Code
Match Scheduled Start Date & Time
Incident Occurrence Date & Time
Venue or Server Location
Game Title
Game Version/Patch Number
Gaming Platform
PC
PlayStation 5
Xbox Series X
Nintendo Switch
Mobile iOS
Mobile Android
Cross-Platform
Team A - Official Team Name
Team A - Captain Name
Team A - Complete Roster (Player IDs & In-Game Names)
Team B - Official Team Name
Team B - Captain Name
Team B - Complete Roster (Player IDs & In-Game Names)
Your Role in This Match
Team Captain
Assistant Captain
Head Referee
Assistant Referee
Observer
League Official
Technical Administrator
Your Full Name
Your Official ID Number
Match Format (e.g., Best of 3, Best of 5)
Current Match Score (Team A)
Current Match Score (Team B)
Current Game State (Map, Round, Time Remaining)
Describe the nature of the incident with precise details. Classify the issue type, specify when and where it occurred, and assess its impact on competitive integrity.
Primary Incident Category
Technical Glitch/Bug
Rule Violation
Equipment Failure
Network Connectivity Issue
Software Crash
Unauthorized Interference
Player Conduct Breach
Other
Severity Level Assessment (1 = Minor, 5 = Critical)
Detailed Incident Description
Exact Game Time/Timestamp of Incident
Specific Map Location/In-Game Coordinates
Which Party Was Directly Involved?
Team A Only
Team B Only
Both Teams
No Specific Team (System-Wide)
Referee/Administrator
Spectator/Observer
Specific Player(s) Involved (In-Game Names & IDs)
Does this incident involve a specific rulebook clause violation?
Specify Rulebook Section, Clause, and Sub-Clause
Is this a recurring technical issue that has happened before in this tournament?
Provide Previous Incident IDs and Brief History
Technical Component Affected (select all that apply)
Game Client
Server
Network Infrastructure
Player Peripheral
Audio System
Visual Display
Anti-Cheat System
Match Broadcasting System
Scoreboard/UI
Physics Engine
Ability/Skill System
Map Geometry
Other
Impact Assessment on Competitive Integrity
No Impact | Minimal Impact | Moderate Impact | Significant Impact | Severe Impact | |
|---|---|---|---|---|---|
Affected Fair Play | |||||
Affected Match Outcome Potential | |||||
Caused Unfair Advantage | |||||
Caused Unfair Disadvantage | |||||
Disrupted Competitive Balance |
Was the incident immediately reported to match officials when it occurred?
Explain the delay in reporting and reason for delayed submission
Estimated Number of Players Affected
Potential Consequences if Left Unresolved
Upload all available evidence to support the incident report. Include visual documentation, system logs, and witness testimonies. Timestamp correlation is critical for accurate review.
Screenshot Evidence - Pre-Incident Game State (mandatory)
Screenshot Evidence - Post-Incident Game State (mandatory)
Video Clip Evidence - Continuous Recording of Incident (mandatory)
Additional Video Angles or Perspectives (optional)
Video Evidence Timestamp References
Game Server Logs (if accessible)
Client-Side Logs/Error Reports
Network Diagnostics/Ping Plotter Data
Witness Statement(s) from Neutral Observers
Were there any chat logs or in-game communications relevant to this incident?
Transcribe Relevant Chat Messages with Timestamps
Evidence Inventory Checklist
Collected? | Evidence Type | File Name/Reference | Capture Time | Submitted By | ||
|---|---|---|---|---|---|---|
A | B | C | D | E | ||
1 | Pre-Incident Screenshot | pre_incident_001.png | 6/30/2025, 2:22 PM | Head Referee | ||
2 | Post-Incident Screenshot | post_incident_001.png | 6/30/2025, 2:22 PM | Head Referee | ||
3 | Server Logs | |||||
4 | Network Diagnostics | |||||
5 | ||||||
6 | ||||||
7 | ||||||
8 | ||||||
9 | ||||||
10 |
Is any evidence withheld pending further review?
Specify Withheld Evidence and Reason
Document all actions taken immediately following the incident, including match pause protocols, communications with teams, and any on-the-spot decisions made by officials.
Was the match officially paused after the incident?
Who Officially Requested the Pause?
Explain Why Match Was Not Paused
Match Pause Start Time
Match Pause End Time
Total Pause Duration (minutes)
Communication Log with Team Captains During Pause
Were any immediate corrective actions attempted during the pause?
Describe Corrective Actions Attempted and Results
Match Timeline & Actions Log
Time | Event/Action | Acting Official | Team Response | Score State | ||
|---|---|---|---|---|---|---|
A | B | C | D | E | ||
1 | 2:22 PM | Incident occurred - Player disconnect | System | N/A | A: 14, B: 9 | |
2 | 2:23 PM | Pause requested by Team A Captain | Referee Smith | Team A: Confirmed/Team B: Acknowledged | A: 14, B: 9 | |
3 | 2:25 PM | Initial investigation started | Head Referee | Both teams waiting | A: 14, B: 9 | |
4 | ||||||
5 | ||||||
6 | ||||||
7 | ||||||
8 | ||||||
9 | ||||||
10 |
Were any official warnings or penalties issued on-the-spot?
Detail Warnings or Penalties Issued
Game State After Resolution Actions
Did both team captains agree to resume play?
Document Objections and Dissenting Team Position
I confirm that all immediate actions taken were logged in real-time and communicated to both teams before resuming play.
Final review and authorization section for head referee and league operations personnel. This section confirms official review, determination of validity, and authorization of any further actions or sanctions.
Head Referee Name
Head Referee Official ID
Head Referee Review Completion Time
Head Referee Validity Determination
Valid Incident - Requires Further Action
Valid Incident - Resolved On-Site
Invalid Incident - No Merit
Incomplete Evidence - Requires Supplemental Information
Escalate to League Operations
Head Referee Official Findings and Rationale
Does this incident warrant official sanctions or penalties beyond on-the-spot actions?
Recommended Sanctions and Justification
Should this incident be escalated to the Tournament Integrity Committee?
Escalation Reason and Urgency Level
League Operations Manager Name
League Operations Manager Official ID
League Operations Approval Timestamp
League Operations Final Disposition
Approved - Sanctions Imposed
Approved - No Further Action
Rejected - Return for Additional Review
Pending - Awaiting Additional Evidence
Referred to Appeals Process
League Operations Final Decision Statement
Head Referee Digital Signature
League Operations Manager Digital Signature
Has an appeal been filed by any involved party?
Appeal Details and Filing Timestamp
Appeal Window Closure Date & Time
I certify that all information in this report is accurate, complete, and submitted in accordance with tournament regulations and code of conduct.
I acknowledge that false reporting or misrepresentation may result in disciplinary action including suspension or permanent ban from tournament participation.
To configure an element, select it on the form.