Get the free Concussion Management Accommodation Request Form - sonoma

This document serves as a request form for students seeking accommodations related to concussion management through the Disability Services for Students at Sonoma State University.

How to fill out concussion management accommodation request

How to fill out Concussion Management Accommodation Request Form

1. Obtain the Concussion Management Accommodation Request Form from your school or workplace.
2. Fill in the personal information section, including your name, date, and contact information.
3. Provide details about your concussion injury, including the date of injury and any relevant medical information.
4. Outline any specific accommodations you are requesting, such as extra time on tests or reduced workload.
5. Have a healthcare provider complete their section of the form to verify your concussion status and recommended accommodations.
6. Review the entire form for completeness and accuracy.
7. Submit the completed form to the appropriate administrative office or designated personnel.

Who needs Concussion Management Accommodation Request Form?

1. Students returning to school after a concussion.
2. Employees recovering from a concussion who need workplace accommodations.
3. Athletes who have sustained a concussion and require modifications to continue their activities.
4. Individuals requiring adjustments due to the impact of concussion-related symptoms on daily functioning.

People Also Ask about

What are the 4 P's of a concussion?

You can conserve energy by using the “Four P's” principle: Prioritize, Plan, Pace, and Position.

What accommodations are available for concussions?

Many students will need temporary academic supports and accommodations to help as they progress through the Return to Learn process. These can include: Environmental Supports: modified school attendance, frequent rest breaks from cognitive/thinking/desk work tasks, reduced screen time.

What are the 5 steps of concussion?

Explaining the NFL's 5-step concussion protocol Step 1: Rest and recovery. This one is simple. Step 2: Light aerobic activities. Step 3: More aerobic exercise and strength training. Step 4: Football specific activities. Step 5: Full football activity.

Which of the following accommodations should be made for a person that has suffered a concussion?

Avoid any activity that places a person at risk of sustaining another concussion. It is critical to balance rest and activity throughout recovery. A gradual return to activities will include increasing and/or decreasing participation in an activity based on how the recovery is progressing.

What are the 6 RS for concussion?

Or even better are the 6 R's: Recognize. Learn the signs and symptoms of a concussion. Remove. If an individual has a concussion or even a suspected concussion, they must be removed from duty immediately. Refer. Seek medical attention. Rest. A minimum of 24 hours for mild symptoms – 72 is better. Recover. Return.

What are the 5 R's of concussion management?

The video below is the first output of a joint concussion education initiative between Brain Injury Australia and Sports Medicine Australia, built around Brain Injury Australia's trademarked “5Rs” of concussion – “Recognise the injury, Removal from play, Referral to a doctor, Rest and then Return to play” – and

What are the 5 things you should do if you might have a concussion?

Concussion – Mild traumatic brain injury: Care instructions Call 911 or go to the hospital right away if you have any of the following: Rest and sleep. Diet. Managing pain. Driving. Alcohol and drugs. Sports and leisure. Rest your brain.

Why is it important to monitor a student's symptoms and school performance after a concussion?

However, in some cases, a concussion can affect multiple aspects of a student's ability to participate, learn, and perform well in school. In turn, the experience of learning and engaging in academic activities that require concentration can actually cause a student's concussion symptoms to reappear or worsen.

For pdfFiller’s FAQs

What is Concussion Management Accommodation Request Form?

The Concussion Management Accommodation Request Form is a document used to formally request accommodations for an individual who has suffered a concussion. It facilitates the process of providing necessary support and adjustments in an educational or occupational setting.

Who is required to file Concussion Management Accommodation Request Form?

Typically, individuals who have been diagnosed with a concussion are required to file the Concussion Management Accommodation Request Form. This may include students, employees, or athletes seeking accommodations to support their recovery.

How to fill out Concussion Management Accommodation Request Form?

To fill out the Concussion Management Accommodation Request Form, individuals should provide personal information, a description of the concussion and its impact on their functioning, any recommended accommodations from a healthcare provider, and relevant contact information for follow-up.

What is the purpose of Concussion Management Accommodation Request Form?

The purpose of the Concussion Management Accommodation Request Form is to ensure that individuals receive appropriate accommodations tailored to their needs during the recovery process after a concussion, promoting their health and well-being.

What information must be reported on Concussion Management Accommodation Request Form?

The information that must be reported on the Concussion Management Accommodation Request Form typically includes the individual's name, contact details, details of the concussion, symptoms experienced, recommended accommodations by a healthcare professional, and any other relevant medical history.