Concussion Clearance Certificate

Download the Concussion Clearance Certificate

The Protocol

Before the athlete can start Stage 5 of the Back To Exercise Plan, he/she should see their medical doctor for clearance to start contact training. The doctor must confirm that the athlete has completed all the components of concussion treatment and recovery up to and including Stage 4.

The following components must be completed:

– return to baseline symptom number & severity score

– return to baseline balance performance

– return to baseline brain function on the CogState / Axon Sports Test

– return to a full school or work day

– completion of Stage 2 to Stage 4 supervised exercise in a safe environment at an intensity that does not cause recurrent concussion symptoms

The doctor can check these components of the protocol on the medical clearance certificate. The issuing of the medical clearance certificate verifies that the athlete is safe to enter a contact training environment or enter an environment with the potential for head injury.   The athlete needs to give the medical clearance certificate to their coach, teacher, competition manager or director of sport  who is able to confirm that the athlete can participate in sport which carries the risk of concussion (contact training).

In the United States it is law in all States that an athlete who has suffered a concussion may not return to activity with the risk of concussion without a medical clearance certificate from a qualified medical doctor.

Last updated 26 March 2015