• Concussion Reporting Form

  • The USA Hockey / Midwest Amateur Hockey Association Concussion Management Protocol and the state statutes require that an athlete be removed from any training, practice or game if they exhibit any signs, symptoms or behaviors consistent with a concussion or are suspected of sustaining a concussion. The player should not return to physical activity until he or she has been evaluated by a qualified licensed medical provider who has provided written clearance to return to sports.

  • This form is to be used after an athlete has been removed from athletic activity due to a suspected concussion to report data to the MWAHA Player Safety Coordinator for use in the USA Hockey Player Safety Initiative.

  •  -  -
    Pick a Date
  • Browse Files
    Cancel of
  •  -
  •  -  -
    Pick a Date
  • Should be Empty:
Jotform Logo
Now create your own JotForm - It's free! Create your own JotForm