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Concussion Information Sheet Adapted from the CDC and the 3rd International Conference on Concussion in Sport Document created 6/15/2009 A concussion is a brain injury and all brain injuries are serious.
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How to fill out concussion information sheet

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How to fill out a concussion information sheet:

01
Begin by carefully reading through the instructions provided on the sheet. Make sure you understand the purpose and importance of the document.
02
Write your personal information accurately in the designated fields. This may include your full name, date of birth, contact information, and any relevant medical history.
03
Provide details about the incident that caused the potential concussion. Note the date, time, and location of the incident, as well as a brief description of what happened.
04
Answer any questions related to the symptoms you have been experiencing since the incident. Include information about headaches, dizziness, memory problems, sensitivity to light or noise, changes in mood, or any other relevant symptoms.
05
Indicate if you have sought medical attention and provide details about any healthcare professionals you have consulted. This could include primary care physicians, neurologists, or specialists in sports medicine.
06
If applicable, provide information about any previous concussions you have experienced. Note the dates, circumstances, and any ongoing symptoms or treatments.
07
Take the time to review your completed concussion information sheet for accuracy and comprehensiveness. Make any necessary corrections or additions before submitting.
08
Keep a copy of the completed sheet for your records, and ensure that it gets submitted to the appropriate party, such as a healthcare provider, school official, or coach.

Who needs a concussion information sheet?

01
Athletes: Individuals participating in sports or physical activities, especially contact sports, should have a concussion information sheet on file.
02
Parents or Guardians: For minors participating in sports or organized activities, parents or legal guardians may be required to complete the concussion information sheet on their behalf.
03
Coaches and Sports Team Personnel: It is important for coaches and other team personnel to have access to concussion information sheets in order to monitor and address potential head injuries among their athletes.
04
Schools and Educational Institutions: Many schools require students, particularly those involved in athletics, to have a concussion information sheet completed and on file.
05
Healthcare Providers: Doctors, nurses, and other healthcare professionals may use concussion information sheets as part of their assessment and treatment process for individuals with head injuries.
06
Employers and Workplace Safety Programs: Some industries that have a higher risk of head injuries, such as construction or manufacturing, may require employees to complete concussion information sheets to ensure proper safety measures are in place.
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The concussion information sheet is a document that provides important information about concussions, including symptoms, treatment, and prevention.
Certain organizations, such as schools and youth sports leagues, are required to file concussion information sheets.
The concussion information sheet can typically be filled out by providing relevant information about the individual or organization and signing to confirm accuracy.
The purpose of the concussion information sheet is to educate individuals about concussions and ensure proper protocols are followed in case of a head injury.
The concussion information sheet may require reporting of symptoms, medical history, previous head injuries, and contact information.
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