Sample Home Concussion Management Form

The Return to Learning (RTL) and Return to Physical Activity (RTPA) Plans have been developed in partnership with Parachute and are based on the most recent research and recommendations of the expert scientific community on concussion, that is the Canadian Guidelines on Concussion in Sport, July 2017 and the Berlin Consensus Statement on Concussion in Sport, October 2016.

The Home Return to School Form is for parents/guardians to track and communicate to the school a student’s progress through the stages of the Return to Learning (RTL) plan and the Return to Physical Activity (RTPA) plan following a diagnosed concussion.

This section includes:

• Background Information on the Concussion Recovery Process
• General Procedures for a Home Concussion Management Form (Return to School Plan)
• Instructions for a Home Concussion Management Form (Return to School Plan)
• Sample Home Concussion Management Form (Return to School Plan)