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AUBURN SOCCER ASSOCIATION
CONCUSSION INFORMATION From
A concussion is a brain injury and all brain injuries are serious. They are caused by a bump,
blow, or jolt to the head, or by a blow to another
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How to Fill Out Concussion Information Form:
01
Start by carefully reading the instructions on the concussion information form. Make sure you understand all the questions and requirements.
02
Begin by providing your personal information such as your name, date of birth, gender, and contact details. Ensure that this information is accurate and up to date.
03
Check if the form requires you to provide any medical history related to previous concussions or head injuries. If so, fill in this section accurately and provide any necessary details, such as the date and circumstances of the injury.
04
The form might also ask about any current symptoms you are experiencing related to a possible concussion. Be honest and thorough in describing your symptoms, including any changes in behavior, difficulties with concentration or memory, headaches, or other physical or cognitive issues.
05
Some concussion information forms may require you to answer questions about your current activities, such as sports participation or physical exertion. If applicable, provide this information accurately and in detail.
06
If the form asks about witnesses to the incident or people who might have observed your symptoms, make sure to include their names and contact information if available.
07
In case you have sought medical attention or received any treatment for the concussion, provide details regarding the healthcare provider, facility, dates, and any prescribed medications or recommendations.
08
Finally, ensure that you have completed all the required sections and reviewed your answers for accuracy. Double-check the form for any additional signatures or consent that might be necessary.
Who Needs Concussion Information Form:
01
Athletes and sports participants: This form is often required for athletes participating in organized sports, especially contact sports, as it ensures that any potential concussions are documented and appropriate actions are taken to protect the individual's health and well-being.
02
Students: Some schools or educational institutions may require students to fill out a concussion information form to monitor and address any potential head injuries sustained during physical activities or accidents on school premises.
03
Employees: Depending on the industry and job roles, employers may require employees to complete concussion information forms to ensure workplace safety and to address any potential head injuries sustained while on the job.
Note: The specific individuals who need to fill out a concussion information form may vary depending on the organization, regulations, or specific circumstances. It is important to consult the relevant authorities or check with the responsible party to determine if you need to fill out this form.
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What is concussion information form?
Concussion information form is a document that contains details about any head injury or concussion that an individual has suffered.
Who is required to file concussion information form?
Athletes, coaches, officials, and medical personnel are required to file concussion information form.
How to fill out concussion information form?
Concussion information form can be filled out by providing details about the individual's name, date of injury, symptoms, and any medical treatment received.
What is the purpose of concussion information form?
The purpose of concussion information form is to track and monitor head injuries to ensure the safety and well-being of athletes.
What information must be reported on concussion information form?
Information such as date of injury, symptoms experienced, any medical treatment received, and clearance to return to play must be reported on concussion information form.
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