What is the concussion return-to-play form template?
When a player has a suspected concussion, coaches, parents and medical staff all need to know the same things: what happened, what symptoms the player has, how far through the return-to-play stages they are, and whether a doctor has cleared them. This template keeps that in one record, updated as the player recovers.
It starts with the player, team and sport, who's completing the form, and the injury itself: date, time, context, what happened, whether the player was removed from play straight away, red-flag signs that need urgent attention, whether they were seen by a doctor and the diagnosis. The symptoms page records today's symptoms, an overall severity score, the first symptom-free day and the player's return to school, study or work.
A stage grid tracks six graduated steps from symptom-limited activity to return to competition, with dates and any setbacks. Full-contact practice and competition sit behind medical clearance: the form asks for the clinician, date and an uploaded clearance letter. Each update is saved as a PDF in your FileIt vault, giving a dated history of the player's return.
- Best for
- Youth and adult sports clubs, schools, coaches and athletic trainers
- Filled in by
- The coach, athletic trainer, first aider or parent
- Time to complete
- About 5 minutes per update
- Includes
- Red-flag checklist, symptom tracker, six-stage progress grid, clearance letter upload
Who uses a concussion return-to-play form?
- A youth rugby coach records a suspected concussion from a Saturday match
- An athletic trainer updates a player's stage progress through the week
- A school tracks a student's return to class alongside their return to sport
- A club requires a clearance letter before a player returns to contact training
- A parent records symptoms at home and shares them with the coach
- A league reviews concussion records at the end of the season
Questions on this concussion return-to-play form
35 questions over 4 pages · includes signature, file upload, conditional questions, multiple pages, consent checkbox, ratings.
1 Player & injury
- Player's name*
- Date of birth*
- Team or club*
- Sport*
- Completed by*
- Parent or guardian (under-18s)
- Parent or guardian's phone asked only when it applies
- Date of injury*
- Time
- Happened during* A game or match · Training · Outside sport
- What happened?*
- Was the player removed from play straight away?*
- Did any of these occur?* Loss of consciousness · Seizure or convulsion · Neck pain or tenderness · Repeated vomiting · Worsening headache · Double vision · Weakness or tingling in arms or legs · Increasing confusion or drowsiness · None of these
- Was the player seen by a doctor or at hospital?*
- Where, when and by whom?* asked only when it applies
- Diagnosis* Concussion confirmed by a doctor · Suspected concussion — not yet assessed · Concussion ruled out by a doctor
2 Symptoms & recovery
- Symptoms today* Headache · Pressure in the head · Dizziness · Nausea · Blurred vision · Sensitivity to light · Sensitivity to noise · Feeling slowed down · Feeling 'in a fog' · Difficulty concentrating · Difficulty remembering · Fatigue
- Overall, how bad are the symptoms today?
- Date of this update*
- First day symptom-free at rest
- Return to school, study or work* Not yet back · Back part-time or with adjustments · Fully back without symptoms · Not applicable
- Adjustments in place asked only when it applies
3 Return-to-play stages
- Stage progress* Not started · In progress · Completed, no symptoms · Symptoms returned
- Dates each stage started and finished*
- Have symptoms returned at any stage?*
- What happened and what was done?* asked only when it applies
- Who supervised the stages?
4 Medical clearance
- Medical clearance* Not yet cleared · Cleared for full-contact practice · Cleared for full return to competition
- Clinician's name and role* asked only when it applies
- Date of clearance* asked only when it applies
- Clearance letter* asked only when it applies
- Date of return to competition asked only when it applies
- Parent or guardian asked only when it applies
- Recorder*
- Signature of the person completing this form*
The concussion return-to-play form, page by page
1 Player & injury
The player's name, date of birth, team, sport, who's completing the form and a parent or guardian with phone for under-18s. The date and time of injury, whether it happened in a game, training or outside sport, a required description, whether the player was removed from play straight away, a required red-flag checklist (loss of consciousness, seizure, neck pain, vomiting, worsening headache, double vision, weakness, increasing confusion), whether they were seen by a doctor and the diagnosis.
2 Symptoms & recovery
A required checklist of fifteen common symptoms with 'No symptoms', a 0–10 severity scale, the date of this update, the first symptom-free day at rest, and return to school, study or work — part-time returns ask what adjustments are in place.
3 Return-to-play stages
A note reminds you that your sport's protocol and the player's doctor set the timing and that symptoms mean stepping back. A required six-row grid marks each stage as not started, in progress, completed with no symptoms, or symptoms returned, with the dates of each stage, whether symptoms have returned (with details) and who supervised.
4 Medical clearance
A note that players shouldn't return to full contact or competition without clearance from a qualified professional, then the clearance status. Any clearance asks for the clinician, the date and a required clearance letter upload; full clearance also asks for the return-to-competition date. A parent acknowledgement appears when a guardian is named, then the recorder's confirmation and signature.
Make the template yours
- Replace the stage names with the exact stages in your sport's governing body protocol
- Add the minimum time per stage from your protocol as help text
- Add your club's concussion policy or a link to it on the first page
- Set notification emails to your welfare or medical lead
- Use one vault folder per player so every update is kept together
- Add a return-to-learn grid if schools are involved
Tips for a better concussion return-to-play form
- If in doubt, sit them out — the form records the decision, but the decision comes first
- Any red-flag sign means urgent medical care, not a form
- Submit a new update at each stage so the history is dated
- Don't let a player move to full contact without the clearance letter uploaded
- Share the record with parents so everyone knows the current stage
Every response becomes a PDF in your vault
Each update is saved as a PDF in your vault, including the clearance letter when one is uploaded, and your team is emailed.
Filter the Responses table by clearance status to see which players are still recovering, and check the stage dates before a player is picked for a game.
- Start from this template. It opens in the FileIt Forms designer — change any question, add pages, set the rules for when questions appear.
- Share it. Turn on a public link, or send it to people by email, each with their own link. They don’t need a FileIt account.
- Get the answers as PDFs. Each response is saved as a PDF in the vault folder you choose, with uploaded files attached — and listed in a Responses table you can export to CSV.
Concussion return-to-play form: frequently asked questions
Is this concussion return-to-play template free?
Yes, it's included in the Forms app on every FileIt account, including the free plan, and every question can be edited.
Does this form tell me when a player can return?
No. It records progress and clearance. Your sport's governing body protocol and a qualified healthcare professional decide when a player can move on and return.
Is this a diagnostic tool?
No. It isn't a concussion assessment. It records what happened, the symptoms reported and the stages completed.
Can I upload the doctor's clearance?
Yes. Any clearance requires the clinician's name, the date and an uploaded clearance letter.
Can I use my sport's own stages?
Yes. Edit the stage grid rows to match your governing body's protocol.
Can I update the record as the player recovers?
Submit the form again at each stage. Each submission is saved as its own dated PDF, so you keep the full history.