Abide by return-to-sport protocols:
- Do not allow the athlete to return without a written clearance from a doctor or nurse practitioner;
- Follow the return-to-sport protocol provided, if not provided use the one in the Policy.
Concussion Reporting Guidelines
This form is for reporting suspected concussions, concussion clearances, confirmed concussions, return-to-sport protocols, and completion of RTS protocols.
- Coaches and Officials of events taking place in Ontario are Designated Persons under Rowan’s Law (Concussion Safety), 2018 and are required to report concussions and suspected concussions.
- Any Coach, Official, parent, or athlete can use this form to report a suspected or confirmed concussion, concussion clearance, return-to-sport protocol, or completion of a return-to-sport protocol.
- Once a suspected concussion has been reported, use this form to report subsequent events: confirmation, clearance, return-to-sport protocol, and/or completion of return-to-sport protocol.
- For more information about the concussion reporting and return-to-sport process, you can review the Concussion Resources and Triathlon Ontario Concussion Policy.
Contact information
Your contact information as the person submitting this report.
Your name as the person submitting this report.
Your current email address as the person submitting this report.
Your current phone number as the person submitting this report.
Injured Athlete Contact Information
Name of the injured athlete.
Email address of the injured athlete, or a parent/guardian if the athlete is under 18.
Current phone number of the injured athlete, or a parent/guardian if the athlete is under 18.
Email address of a parent/guardian or alternate contact, if required. Note that concussions often result in the injured athlete being unable to use screens and devices to communicate by email, so we strongly recommend including an alternate contact.
Current phone number of a parent/guardian or alternate contact, if required.
Type of Report
What to Report
You may find out about a suspected or confirmed concussion in several ways.
- You may be present at or called to the scene of an injury and suspect a concussion;
- You might receive a concussion protocol from an athlete who has a concussion from outside of triathlon;
- You might receive a concussion report directly from a another coach, governing body, club, or school; or,
- You might receive a concussion report from Triathlon Ontario.
In all cases coaches and officials are required to fill out this report. This form confirms that you are aware of the concussion and informs Triathlon Ontario of each step in the process. It also allows us to fulfill the statutory requirement to inform other sports and schools.
Fill out this report again each time the athlete receives a clearance, a confirmation, a return-to-sport protocol, or completes their return-to-sport-protocol. Please enter the type of report. You can select all that apply.
Suspected Concussion (Injury)
Describe the circumstances of the injury and the actions taken.
Confirmation or Return-to-Sport Protocol
Please upload a .pdf of the Doctor or Nurse Practitioner's concussion confirmation or RTS protocol. (Typically these will be supplied at the same time. Any RTS protocol issued by an MD or NP will be considered a confirmation.)
Completion of Return-to-Sport Protocol
Please enter the date that the athlete completed their RTS protocol. If required by a Doctor or Nurse Practitioner in the RTS protocol, the athlete will need to be cleared before returning to sport. If using the Triathlon Ontario RTS protocol, the athlete may return to sport on successful completion.
Date Format: YYYY dash MM dash DD
Clearance
Please upload a .pdf of the Doctor or Nurse Practitioner's concussion clearance.
Notes
Please enter any additional information relevant to this report.
Please upload any additional files relevant to this report. (Accepts all file types.).
This field is for validation purposes and should be left unchanged.
