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CALIFORNIA STATE UNIVERSITY, SAN BERNARDINO
DEPARTMENT OF INTERCOLLEGIATE ATHLETICS
Concussion Reporting Acknowledgement Form
I have read and understand the NCAA Concussion Fact Sheet. I understand
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How to fill out concussion acknowledge sheet form
How to fill out a concussion acknowledge sheet form:
01
Obtain the form: Contact your school, organization, or healthcare provider to obtain a copy of the concussion acknowledge sheet form. It may also be available online for download.
02
Read the instructions: Carefully review the instructions provided with the form. Make sure you understand all the requirements and expectations.
03
Personal information: Start by filling out your personal information section. This may include your full name, date of birth, address, phone number, and email address. Ensure accuracy and legibility.
04
Concussion education: Some forms may require you to acknowledge that you have received education about concussions. If you have attended any concussion awareness programs or received informative materials, check the appropriate box or write the name of the program attended.
05
Signature: Sign and date the form in the designated areas. This signifies that you understand and acknowledge the risks associated with concussions.
06
Parent or guardian signature (if applicable): If the form is for a minor, a parent or guardian may need to sign and provide their contact information as well. Check if this section is applicable and complete it accordingly.
07
Return the form: Submit the completed form to the appropriate authority. Follow any instructions provided, such as returning it to your coach, school nurse, or other designated person.
Who needs a concussion acknowledge sheet form?
01
Athletes: Many sports organizations, schools, and teams require athletes to complete a concussion acknowledge sheet form. This helps ensure that participants are aware of the risks associated with concussions and have received proper education.
02
Parents or guardians: If the form is for a minor athlete, a parent or guardian may need to sign the form to indicate their acknowledgement and consent.
03
Coaches and staff: In some cases, coaches and staff members may also be required to fill out and sign the concussion acknowledge sheet form. This emphasizes the importance of concussion awareness and creates a unified approach in protecting athletes.
Remember, the specific requirements for who needs to fill out the form can vary depending on the organization, school, or healthcare provider. Always follow the guidelines provided by the relevant authority to ensure compliance.
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What is concussion acknowledge sheet form?
Concussion acknowledge sheet form is a document used to acknowledge and inform individuals about the risks and symptoms of concussions, particularly in sports and recreational activities.
Who is required to file concussion acknowledge sheet form?
Athletes, parents/guardians of minor athletes, coaches, and medical personnel are required to file concussion acknowledge sheet form.
How to fill out concussion acknowledge sheet form?
The form typically requires the individual to acknowledge that they have received information about concussions, understand the risks, and agree to report any symptoms to the appropriate personnel.
What is the purpose of concussion acknowledge sheet form?
The purpose of the form is to raise awareness about concussion risks, educate individuals on symptoms, and ensure proper reporting and management of concussions.
What information must be reported on concussion acknowledge sheet form?
Information such as name, date, signature, acknowledgment of risks and symptoms, and agreement to report symptoms must be reported on the form.
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