Instructions for the School Concussion Management Form (Return to School Plan)

At each stage, the School Concussion Management Form (Return to School Plan) for Return to Learning (RTL) and Return to Physical Activity (RTPA) (hard copy/electronic) will go back and forth between the school and home.

• Review the activities (permitted and not permitted) at each stage prior to beginning the plan.
• The school (for example, teacher, collaborative team lead) provides appropriate activities and records student’s progress by checking, dating, initialling completion of each stage and communicating information (form) to parent/guardian.
• Within each stage, the parent/guardian completes, checks, dates and signs the student’s tolerance to those activities (that is, no returning, new or worsening symptoms) giving permission for the student to progress to the next stage and returns completed form to school.