Abstract Objective To analyze the incidence and injury pattern in Spanish football (soccer) referees. Method In this retrospective study, Spanish referees filled out an online survey during a training camp organized by the Referees Technical Committee of the Real Federacion Espanola de Futbol. The survey included questions on aspects of refereeing qualifications, training and matches, injury patterns (type, location, and circumstances), and absence of the 2018–2019 season. Results A total of 28 elite referees (24.1%) out of 116 reported having suffered one injury during the season. Significant differences in the frequency of injuries between match (MRs) and assistant referees (ARs) were observed. MRs were 1.90 (95% CI 1.008–3.582) times as likely to suffer an injury compared to ARs. The incidence of match injuries for MRs officiating in the top division of the Spanish Football League was 1.30 (95% CI 0.0–3.82) per 1000 match hours while for ARs was 0.7 (95% CI 0.0–2.1); the incidence of training injuries was considerably lower in both groups (0.4 (95% CI 0.0–0.9) vs. 0.3 (95% CI 0.0–0.6). Hamstring- and calf-related muscle problems were the most common injury diagnoses in elite referees. Injured referees had, on average, 2 weeks of absence from training and competition. Conclusion Elite MRs had a 90% increase in the risk of suffering an injury in comparison with elite ARs. The incidence of match injury or training injury was very low in both groups, despite that, they should continue carrying out preventive programs specially targeted for hamstring- and calf-related muscle problems.