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PERRY BOARD OF EDUCATIONFFAEAECONCUSSION AND HEAD INJURY ACKNOWLEDGEMENT AND INFORMATION SHEET In compliance with Oklahoma Statute Section 24155 of Title 70, this acknowledgement form is to confirm
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To fill out a concussion and head injury report, follow these steps:
02
Start by providing your personal information, such as name, age, and contact details.
03
Describe the circumstances that led to the injury and provide a detailed account of what happened.
04
Include any symptoms you experienced after the injury, such as headaches, dizziness, confusion, or memory loss.
05
If you sought medical attention, include the details of the healthcare professional you visited and any treatments or medications prescribed.
06
Mention any previous head injuries or concussions you have had in the past.
07
If applicable, include information about witnesses to the injury or any relevant surveillance footage.
08
Sign and date the report to certify that the information provided is accurate and complete.
09
Submit the completed report to the relevant authority or medical professional as required.

Who needs concussion and head injury?

01
Concussion and head injury reports are typically needed by individuals who have experienced a head injury or concussion. This includes athletes who participate in contact sports, individuals involved in accidents or falls, soldiers, and anyone who has suffered a blow to the head. The reports are used to document the incident, assess the severity of the injury, and determine appropriate treatment or further medical evaluation.
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Concussion is a type of traumatic brain injury that affects the function of the brain. Head injury refers to any trauma to the head that can result in damage to the brain.
Healthcare professionals, coaches, school administrators, and other individuals who are involved in the care of athletes or individuals at risk of head injuries are required to file concussion and head injury reports.
Concussion and head injury reports can be filled out by providing detailed information about the injury, including the cause, symptoms, treatment, and follow-up care. This information should be submitted to the appropriate authorities for review.
The purpose of concussion and head injury reporting is to ensure that individuals who have experienced head injuries receive appropriate care and follow-up, and to track trends and patterns of head injuries for prevention and intervention purposes.
Information that must be reported on concussion and head injury includes the cause of the injury, symptoms experienced, treatment received, follow-up care, and any recommendations for future prevention.
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