Pioneer Valley Christian Academy

Concussion Policy


This policy provides for the implementation of MA 105 CMR 201.000, Head Injuries and Concussions in Extracurricular Athletic Activities. The policy applies to all public middle and high school students who participate in any extracurricular athletic activity. This policy provides the procedures and protocols for Pioneer Valley Christian Academy in the management of and prevention of sports-related head injuries within the district or school. Review and revision of this policy is required every two years.

Pre-participation Requirements and Training

Concussion training is a pre-participation requirement for all students and must be completed prior to practice or competition. The following persons annually shall complete one of the head injury safety training programs approved by Pioneer Valley Christian Academy (PVCA).

  • Coaches
  • Volunteers
  • School nurses
  • Athletic directors
  • Parents of a student who participates in an extracurricular athletic activity
  • Students who participate in an extracurricular athletic activity.

This requirement may be met by:

  • completing and submitting the Pre-Participation Head Injury/Concussion Reporting Form to the athletic director (The questionnaire will be reviewed by the school nurse prior to athletic participation. The school nurse will provide appropriate follow-up when necessary.), and

  • completing an approved online program listed on the FRS website and pre-participation questionnaire, and providing a certificate of completion to the athletic director, or

  • signing an acknowledgement that they have read and understand written materials provided to them by the athletic director.

The athletic director will keep all signed acknowledgements for three years.

The training must be repeated every subsequent year.

Game officials must also complete an approved training annually and provide FRS with verification of completion upon request.

Additionally, students who plan to participate in extracurricular athletic activities and their parents must complete and sign the pre-participation Athletic Participation Form prior to each season of participation.

The questionnaire will be distributed through the athletic department and may also be obtained in the health office. Annually, students are also required to provide a physical exam to the school nurse’s office. No student shall be medically cleared for extracurricular athletic activities until the school nurse has reviewed both the questionnaire and physical exam. The school nurse shall consult with the student’s primary care physician as necessary regarding a student’s medical history and/or eligibility.

PVCA may use a student’s history of head injury or concussion, or medical history as a factor to determine whether to allow the student to participate in an extracurricular athletic activity or whether to allow such participation under specific conditions or modifications.

Additional parental requirement:

If a student sustains a head injury or concussion during the season, but not while participating in an extracurricular athletic activity, the parent shall complete the Report of Head Injury Form and submit to the school nurse.

Exclusion from Play

  • Any student, who during a practice or competition, sustains a head injury or suspected concussion, or exhibits signs and symptoms of a concussion or loses consciousness, even briefly, shall be removed from the practice or competition immediately and may not return to the practice or competition that day.

  • The student shall not return to practice or competition unless and until the student provides medical clearance. The coach or athletic trainer shall provide the necessary forms for the student to take to their medical provider. These include a letter explaining the need for the medical clearance from student’s physician, and if indicated an academic recovery plan and an athletic return-to-play protocol.

  • The coach shall communicate the nature of the injury directly to the parent in person or by phone immediately after the practice or competition in which a student has been removed from play due to a head injury, suspected concussion signs and symptoms of a concussion, or loss of consciousness. The coach also must provide this information to the parent in writing, whether paper or electronic format by the end of the next business day.

  • The coach or his or her designee shall communicate, by the end of the next business day, with the Athletic Director and school nurse that the student has been removed from practice or competition for a head injury, suspected concussion, signs and symptoms of a concussion, or loss of consciousness.

Return to Play

A PVCA multidisciplinary team will develop a plan for the student’s return to play from the information provided by the student’s primary care physician. This team may consist of the school nurse, school physician, teaching staff, guidance counselor, primary care physician or physician managing the student’s recovery, and parent.

Student must be symptom free and medically cleared in order to return to play. The following individuals may authorize a return to play:

  • A duly licensed physician,
  • A duly licensed certified athletic trainer in consultation with a licensed physician;
  • A duly licensed nurse practitioner in consultation with a licensed physician, or
  • A duly licensed neuropsychologist in coordination with the physician managing the student’s recovery.

Final return to play requires the approval of the school nurse.

Athletic Director Responsibilities

The Athletic Director participates in the biannual review and revision of the policy.

The Athletic Director completes an annual training.

The Athletic Director shall:

  • Ensure the training of coaches, staff, parents, volunteers and students;
  • Maintain certificates of completion, attendance rosters, and signed affidavits;
  • Ensure that the medically cleared list is provided to all coaches, assistants, and volunteers and that no student participates without this clearance;

  • Ensure the Report of Head Injury Forms are completed by parents or coaches and reviewed by the school nurse;
  • Ensure that athletes are prohibited from engaging in any unreasonably dangerous athletic technique that endangers the health or safety of an athlete, including using a helmet or any other sports equipment as a weapon;

  • Maintain records of annual trainings, completions, affidavits, and/or attendance rosters for three years.
  • Report annual statistics to the Department of Public Health.The total number of Head Injury Reports received from both coaches and parents;

  • The total number of students who incur head injuries and suspected concussions when engaged in any extracurricular athletic activities.

Coach Responsibilities

The coach completes the annual training and provides the athletic director with a certificate of completion.
The coach shall:

  • Identify athletes with head injuries or suspected concussions that occur in practice or competition and remove them from play.
  • Complete the Report of Head Injury Form upon identification of a student with a head injury or suspected concussion that occurs during practice or competition;

  • Promptly notify parent of any student removed from practice or competition and provide same notification in writing or electronically by the end of the next business day;

  • Promptly notify the athletic director and school nurse of any student removed from practice or competition;
  • Teach techniques aimed at minimizing sports-related head injury;
  • Discourage and prohibit athletes from engaging in any unreasonably dangerous athletic technique that endangers the health or safety of an athlete, including using a helmet or any other sports equipment as a weapon.

School Nurse Responsibilities:

The school nurse complete the annual training.

The school nurse participate in the biannual review and revision of the policy.

The school nurse shall:

  • Review all pre-participation questionnaires;
  • Review all annual physical exams;
  • Review all Report of Head Injury reports;
  • Maintain all questionnaires, physical exams, Report of Head Injury forms and any other pertinent medical information in the student health record.

  • Share on a need to know basis any head injury information regarding a student that may impact their ability to participate in extracurricular athletic activities or places a student at greater risk for repeated head injuries;

  • Participate in the reentry planning for students to discuss any necessary accommodations or modifications with respect to academics, course requirements, homework, testing scheduling and other aspects of school activities consistent with a graduated reentry plan for return to full academic and extracurricular athletic activities after a head injury and revising the health care plan as needed;

  • Monitor recuperating students with head injuries and collaborate with teachers to ensure that the graduated reentry plan is being followed;

  • Provide ongoing educational materials on head injury and concussion to teachers, staff and students.

Record Maintenance

The PVCA shall maintain the following record for three years:

Verifications of completion of annual trainings;

Pre-participation Questionnaires;

Annual physical exams;

Head Injury Reports;

Concussion Return to Play Protocols for injured students;

These records will be made available to the Department of Public Health and DESE upon request or in connection with any inspection or program review.

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