In the event that the Coach, Trainer, athlete, or official suspects possible concussion during an activity:

1. Athlete is removed from play and evaluated by a medical professional.
2. Removal from play and/or Incident Report Form should be completed by the coach
   • Return to Play Form
   • Student Incident Injury Report
3. Return to Play Form should then be completed by a medical professional
   • Return to Play Form
4. Athlete may return once the RTP form has been completed and turned in to the school nurse.

1. Provider should complete Section 2 of the Return To Play form
2. The student can be released to return to activity immediately upon receipt.

1. Immediate removal from activity
2. Fill out triplicate form Student Athlete Removal From Participation. Provide original to parent if available or student in the case that a parent is not available. Other copies should be dispersed as indicated on form
3. Complete Accident Incidence Report and turn in to Athletic Director
4. Student, upon returning to school and symptom free for 24hrs, begins the return to play protocol

1. Student takes post injury test
2. School advertises MSBSD options for continued support to families including an optional clinical assessment, vestibular- ocular-motor screen, and continuing concussion management by a trained and certified school neuropsychologist or licensed clinical psychologist
3. Post-injury ImPACT results along with the Healthcare Provider Return To Play form are provided to athlete and parent to take to a qualified medical provider trained in concussion management
4. When the return to play protocol is complete, the Healthcare Provider Return To Play form is turned into the athletic director and filed
5. Athlete returns to play