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CONCUSSION CHECKLIST (Revision #3)Name:Age:Grade:Sport:Date of Injury:Time of Injury:On Site Evaluation Description of Injury:Has the athlete ever had a concussion? Bestows there a loss of consciousness?
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How to fill out concussion evaluation checklist

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How to fill out concussion evaluation checklist

01
Step 1: Obtain a concussion evaluation checklist. This can be obtained from a healthcare professional or downloaded from reputable sources online.
02
Step 2: Read the instructions and familiarize yourself with the different sections of the checklist.
03
Step 3: Gather all necessary information about the individual being evaluated, including their name, age, and medical history.
04
Step 4: Begin filling out the checklist by answering the questions or providing the required information for each section.
05
Step 5: Use the provided rating scales or checkboxes to indicate the severity or presence of specific symptoms or behaviors.
06
Step 6: Be as accurate and detailed as possible when describing symptoms and behaviors, providing specific examples when relevant.
07
Step 7: Consult with a healthcare professional if you have any questions or need clarification on any part of the checklist.
08
Step 8: Review and double-check your responses to ensure they are complete and accurate.
09
Step 9: Submit the completed concussion evaluation checklist to the appropriate healthcare professional or organization as instructed.

Who needs concussion evaluation checklist?

01
Athletes participating in contact sports
02
Individuals who have suffered head injuries or concussions
03
Healthcare professionals conducting evaluations for concussion-related symptoms
04
Sports teams, schools, and organizations implementing concussion management protocols

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