Coaches’ Clipboard
Signs and Symptoms
These signs and symptoms may indicate that a concussion has occurred.
SIGNS OBSERVED BY COACHING STAFF: SYMPTOMS REPORTED BY ATHLETE:
l Appears dazed or stunned l Headache or “pressure” in head
l Is confused about assignment or position l Nausea or vomiting
l Forgets sports plays l Balance problems or dizziness
l Is unsure of game, score, or opponent l Double or blurry vision IMPORTANT PHONE NUMBERS:
l Moves clumsily l Sensitivity to light EMERGENCY MEDICAL SERVICES
l Answers questions slowly l Sensitivity to noise
Name: _____________________________________________________________________________________________________________________________
l Loses consciousness(even briefly) l Feeling sluggish, hazy, foggy, or groggy
l Shows behavior or personality changes l Concentration or memory problems Phone: ______________________________________________________________________________________________________________________________
l Can’t recall events prior to hit or fall l Confusion TEAM PHYSICIAN
l Can’t recall events after hit or fall l Does not “feel right”
Name: _____________________________________________________________________________________________________________________________
Next Steps Phone: ____________________________________________________________________________________________________________________________
If you suspect that a player has a concussion, you should take the HOSPITAL
following steps:
Name: _____________________________________________________________________________________________________________________________
1 Remove athlete from play.
Phone: ____________________________________________________________________________________________________________________________
2 Ensure athlete is evaluated by an appropriate health care professional.
Do not try to judge the seriousness of the injury yourself. For immediate attention, CALL 911
3 Inform athlete's parents or guardians about the known or possible
concussion and give them the fact sheet on concussion.
Create Awareness.
4 Allow athlete to return to play only with permission from an appropriate
health care professional. Prevent Injuries.
If you think your athlete has sustained a concussion...
aHead of the Game!
Take him/her out of play, and seek the advice of a health care professional
experienced in evaluating for concussion. For more information, visit
www.chartisinsurance.com/
aheadofthegame
Insurance underwritten by National Union Fire Insurance Company of Pittsburgh, Pa., with its principal place of business in New York, NY.
Coverage may not be available in all states.