CIF Graded Concussion Symptom Checklist 2015-2025 free printable template

CIF GRADED CONCUSSION SYMPTOM CHECKLIST Today s Date Time Hours of Sleep Date of Diagnosis Grade the 22 symptoms with a score of 0 through 6. o Note that these symptoms may not all be related to a concussion* Baseline Score Post Concussion Score You can fill this out at the beginning of the season as a baseline after a good night s sleep. If you suffer a suspected concussion use this checklist to record your symptoms daily. o Be consistent and try to grade either at the beginning or end...

How to fill out concussion symptom sheet form

How to fill out CIF Graded Concussion Symptom Checklist

1. Obtain a copy of the CIF Graded Concussion Symptom Checklist.
2. Read the instructions carefully at the top of the checklist.
3. Identify the individual who has experienced a concussion.
4. Review the symptoms listed in the checklist, which may include headaches, dizziness, and sensitivity to light.
5. Ask the individual to rate the severity of each symptom on a scale provided (often from 0 to 6).
6. Record the scores next to each symptom.
7. Ensure the individual completes the checklist in a quiet environment to reduce distractions.
8. Review the completed checklist for accuracy.
9. Submit the checklist to the appropriate medical personnel for further assessment.

Who needs CIF Graded Concussion Symptom Checklist?

1. Athletes who have sustained a concussion.
2. Coaches and trainers monitoring the health of athletes.
3. Medical professionals assessing concussion symptoms.
4. Schools and sports organizations for compliance and safety measures.

People Also Ask about concussion symptom inventory

What is the checklist for concussion?

Balance problems or dizziness, or double or blurry vision. Bothered by light or noise. Feeling sluggish, hazy, foggy, or groggy. Confusion, or concentration or memory problems.

What are the 22 signs symptoms of a concussion?

Physical signs and symptoms of a concussion may include: Headache. Ringing in the ears.Symptoms in children Dazed appearance. Listlessness and tiring easily. Irritability and crankiness. Loss of balance and unsteady walking. Excessive crying. Change in eating or sleeping patterns. Lack of interest in favorite toys. Vomiting.

What is the graded symptom checklist scale?

Symptoms are rated on a scale of 0 (“no symptoms”) to 6 (“severe”). The higher the score, the higher the symptom severity (McCrea et al, 2003). Please note that the PCS is a subjective measure that has been used to more objectively measure the symptoms described in the GSC (Lovell et al, 2006).

What are the 5 major symptoms of a concussion?

Concussion Danger Signs One pupil larger than the other. Drowsiness or inability to wake up. A headache that gets worse and does not go away. Slurred speech, weakness, numbness, or decreased coordination. Repeated vomiting or nausea, convulsions or seizures (shaking or twitching).

How is the RPQ scored?

The RPQ-13 score is potentially 0–52, where higher scores reflect greater severity of post concussive symptoms. The RPQ-13 items are associated with a later cluster of symptoms, although the RPQ-3 symptoms of headaches, dizziness and nausea may also be present.

What is the GSC concussion scale?

The Glasgow Coma Scale (GCS) is the most common scoring system used to describe the level of consciousness in a person following a traumatic brain injury. Basically, it is used to help gauge the severity of an acute brain injury.

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What is CIF Graded Concussion Symptom Checklist?

The CIF Graded Concussion Symptom Checklist is a standardized tool used to assess a person's symptoms following a concussion. It helps in identifying the severity of symptoms and assists in making decisions about return-to-play protocols.

Who is required to file CIF Graded Concussion Symptom Checklist?

The CIF Graded Concussion Symptom Checklist must be filed by coaches, athletic trainers, or medical personnel whenever a student-athlete is suspected of having a concussion.

How to fill out CIF Graded Concussion Symptom Checklist?

To fill out the CIF Graded Concussion Symptom Checklist, the assessor should first review the symptoms listed in the checklist with the athlete and then have the athlete rate the severity of each symptom on a scale provided, typically ranging from 0 (none) to 6 (severe).

What is the purpose of CIF Graded Concussion Symptom Checklist?

The purpose of the CIF Graded Concussion Symptom Checklist is to provide a systematic approach for assessing concussion symptoms, which aids in the diagnosis, management, and safe return-to-play of athletes who have suffered a concussion.

What information must be reported on CIF Graded Concussion Symptom Checklist?

The CIF Graded Concussion Symptom Checklist must report information including the athlete's name, date of assessment, symptoms experienced, severity ratings of each symptom, and any additional relevant observations by the assessor.