Templates
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Concussion Policy and Protocol Implementation Roles and Responsibilities Matrix Templates [word doc]
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Sample internal email to staff: Student diagnosed with concussion
A sample email to send to school staff about accommodations for students returning to school following a concussion.
109.36 KB PDF
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Sample school board concussion policy template
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Pre-season concussion education sheet
Have all stakeholders review and sign this education sheet, at the time of sport registration or before the beginning of each sports season, to confirm that all participants received key information about concussion.
29.83 KB Word
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Medical clearance letter
Before returning to full contact practice and game play, each athlete must provide their coach with a standardized Medical Clearance Letter that specifies that a medical doctor or nurse practitioner has personally evaluated the patient and has cleared the athlete to return to sport.
27.78 KB Word
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Medical assessment letter
A medical assessment letter should be provided to athletes diagnosed with a concussion, indicating a concussion has been diagnosed. Athletes that are determined to have not sustained a concussion must be provided with a Medical Assessment Letter indicating a concussion has not been diagnosed and the athlete can return to school, work and sport activities without restriction.
29.82 KB Word
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Pan-Canadian harmonized school concussion protocol template
This template provides an example of a concussion protocol that aligns with the Canadian Guideline on Concussion in Sport.
199.92 KB PDF
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Canadian harmonized sport concussion protocol template
This template provides an example of a concussion protocol that aligns with the Canadian Guideline on Concussion in Sport, 2nd edition.
363.69 KB Word