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School Names student displayed symptom(s) of a possible concussion.×Student removed from play with no reentry until evaluated by a licensed health care provider. Students Name: Date/Time of Suspected
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How to fill out this student displayed symptoms

01
Observe and assess the student's displayed symptoms
02
Take note of any physical symptoms such as fever, coughing, or difficulty breathing
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Check for any psychological or emotional symptoms such as anxiety, sadness, or irritability
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Document any observed symptoms and their duration
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Consult a healthcare professional or school nurse for further guidance
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Follow any recommended protocol or guidelines for addressing the symptoms

Who needs this student displayed symptoms?

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School administrators

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This student displayed symptoms are indicators or signs of a health issue or condition that can be observed or reported by others.
Healthcare professionals or school staff members are required to file this student displayed symptoms.
To fill out this student displayed symptoms, detailed information about the symptoms observed should be recorded accurately in the designated form.
The purpose of this student displayed symptoms is to prompt timely intervention and appropriate medical attention for the student exhibiting the symptoms.
The information reported on this student displayed symptoms should include the specific symptoms observed, the date and time of onset, and any relevant medical history.
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