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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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.
143.19 KB PDF
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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.
343.40 KB PDF/UA
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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.
266.29 KB Word