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Puyallup School District Student Sports Concussion, Head Injury and Sudden Cardiac Arrestor 3422 F3 StudentsCONCUSSION AND SUDDEN CARDIAC ARREST RETURN TO PLAY FORM Student: Address: Phone Number:School:
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01
Concussion Report:
02
Start by providing a detailed description of the incident that led to the concussion.
03
Mention any symptoms experienced by the individual, such as dizziness, headache, or memory loss.
04
Include the date and time of the incident.
05
Provide information about the location where the concussion occurred.
06
List any witnesses present during the incident.
07
Sudden Cardiac Report:
08
Begin by describing the symptoms experienced by the individual, such as chest pain, shortness of breath, or fainting.
09
Include information about the date and time when the symptoms were first noticed.
10
Mention any relevant medical history or pre-existing conditions that may contribute to sudden cardiac events.
11
Provide details about any treatment or first aid provided prior to seeking medical assistance.
12
Include the contact information of the person filling out the report.

Who needs concussion and sudden cardiac?

01
Concussion Report:
02
Any individual suspected of having suffered a concussion, whether they are athletes, students, or regular individuals.
03
Coaches, trainers, or medical professionals who are responsible for assessing and documenting concussions.
04
Sudden Cardiac Report:
05
Individuals who experience symptoms of sudden cardiac events, such as chest pain, shortness of breath, or fainting.
06
Bystanders or witnesses who observe someone potentially experiencing sudden cardiac issues.
07
Medical professionals or first responders who are responsible for assessing and treating individuals with sudden cardiac symptoms.
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Concussion is a type of brain injury that affects normal brain function, usually caused by a blow to the head. Sudden cardiac arrest is a condition in which the heart suddenly stops beating.
Schools, clubs, and sports organizations are typically required to file reports on concussion and sudden cardiac incidents.
Concussion and sudden cardiac reports are usually filled out online through a designated reporting system provided by relevant authorities.
The purpose of reporting on concussion and sudden cardiac incidents is to track and analyze data to improve safety measures and protocols.
Information such as date of incident, individual involved, symptoms, actions taken, and follow-up care must be reported on concussion and sudden cardiac.
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