Sports · free template

Concussion Incident Report

Record a suspected concussion at the time: how it happened, signs observed, symptoms reported, removal from play and the return-to-play steps that follow.

A ready-to-use sports & recreation form for small teams who need a reliable intake process: 29 questions, 2 pages, 4 conditional rules.

Questions: 29
Pages: 2
Layouts: classic
Time to complete: ≈ 9 min
Conditional rules: 4

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Compliance checklist

Ready to publish

Payment items priced — passingEvery payment question charges a real amount, so a submission always records a payment.
Conditional logic resolves — passingEvery rule points at a question or page that exists in this template.
Medical disclaimer present — passingThis form does not provide medical advice, diagnosis or treatment. Information you share here is not a substitute for care from a qualified clinician. In an emergency, contact your local emergency service immediately.
Question labels unique — passingLogic and exports address questions by label, so duplicates are ambiguous.

What happens after submit: nothing is stored in this preview. On your own copy, every response triggers an instant email notification and lands in your response dashboard, ready to export or forward.

Happy with it? Take a copy into your workspace — every question, rule and setting comes with it.

Who this template is for

Concussion Incident Report is built for small teams who need a reliable intake process who need to collect the same complete information from everyone.

Small teams who need a reliable intake process working in sports & recreation.
Teams who need to collect the same complete information from everyone without writing code or paying for a custom build.
Anyone replacing chasing missing details over email with one structured record per enquiry.
Respondents are the people you send it to — the form asks them 29 questions across 2 screens.

Why this form is useful

It removes the cost of chasing missing details over email and turns each submission into a record your team can act on immediately.

21 questions are required, so submissions arrive complete instead of needing a follow-up email.
It records a signature you can keep as proof of agreement.
It pins the request to a specific date.
It allows multiple selections without free text.
Conditional logic hides 4 questions until they are relevant — shorter forms convert better than long ones.
Splitting the form across 2 pages keeps each screen short and shows respondents how much is left.
Every response is stored, searchable and exportable, so nothing depends on one person's inbox.

How to use this template

From copy to live form is a few minutes of work, and every step is reversible.

1Press “Use this template” — a fresh copy of Concussion Incident Report lands in your workspace, ready to edit.
2Rename or delete any question, and change what is required. Nothing here is fixed.
3Open Notifications and add the email addresses that should be alerted on each submission; add an auto-reply to the respondent if the form collects an email address.
4Publish it, then either share the link directly or paste the embed snippet into your site — the embedded form resizes to fit and loads no marketing or advertising trackers.
5Watch responses land in Submissions, where you can filter, label and export them to CSV or PDF.

Logic and conditions blueprint

Exactly how this form behaves as it is answered — 4 conditional rules ship with it.

Features conditional validation: if “Was the athlete removed from play immediately?” is No, “Why they were not removed immediately” becomes mandatory before the form can be sent.
Features conditional validation: if “Was there any loss of consciousness?” is Yes, “How long, as near as known” becomes mandatory before the form can be sent.
Features conditional validation: if “Is the athlete under 18?” is Yes, “When a parent or guardian was told” becomes mandatory before the form can be sent.
Features conditional validation: if “Has the athlete been assessed by a clinician?” is Yes, “Clinician name and date assessed” becomes mandatory before the form can be sent.
All 4 rules are editable in the Logic tab, and the built-in checker warns about rules that contradict each other.

About this template

A suspected concussion is recorded by whoever was there, usually a coach or trainer, and the value of the record depends on it being written the same day. The first page captures the athlete, their age and team, and the incident: date, time, sport, whether it happened in training or a match, how the head was struck or shaken, whether anyone saw it, and whether the athlete lost consciousness and for how long. Signs observed by others and symptoms reported by the athlete are listed separately, because they are different kinds of evidence. The second page covers what was done: whether the athlete was removed from play immediately, who made that decision, whether emergency care was called, when a parent or guardian was told, and whether the athlete was left alone afterwards. It ends with the medical follow-up and the return-to-play stages, each needing a date and a sign-off. Concussion protocols are set by governing bodies and clinicians, so the form records what happened and who cleared each stage rather than giving guidance.

What this form asks

Every question is editable — rename it, make it optional, or delete it entirely.

Page 1 — Athlete and incident

Athlete full namerequired
Date of birthrequired
Is the athlete under 18?required
Team or squadrequired
Sportrequired
Date of the incidentrequired
Approximate time
Settingrequired
How the injury happenedrequired
Did anyone see it happen?required
Was there any loss of consciousness?required
How long, as near as known
Signs observed by othersrequired
Symptoms the athlete reportedrequired

Page 2 — Action taken and return to play

Was the athlete removed from play immediately?required
Why they were not removed immediately
Who made the decision to remove themrequired
Was emergency care called?required
Was the athlete left alone after the incident?required
When a parent or guardian was told
Who reported the incidentrequired
Has the athlete been assessed by a clinician?required
Clinician name and date assessed
Return-to-play stages completedrequired
Date of written clinical clearance
Who signed off the return to play
Anything else that should be on the record
Reported byrequired
Date recordedrequired

29 questions in total.

Example of a completed concussion incident report form

A sample record showing how a coach might document a suspected concussion on the day it happened.

Athlete full name: Casey Ibarra
Team or squad: Under-16s Hockey
Date of the incident: 04/04/2026
Setting: Match
How the injury happened: Collided with another player going for the ball and hit the back of her head on the pitch.
Was there any loss of consciousness?: No
Signs observed by others: Dazed or blank look, Slow to get up
Was the athlete removed from play immediately?: Yes
Has the athlete been assessed by a clinician?: Yes

Sample data — no real people, addresses or records are shown.

How the form changes as it's filled in

This template ships with 4 conditional rules, grouped into 4 behaviours driven by 4 questions. Everything below is already set up — edit or delete any rule once the template is in your workspace.

Driven by “Was the athlete removed from play immediately?”

Makes answers required
If “Was the athlete removed from play immediately?” is No, “Why they were not removed immediately” becomes required before the form can be submitted.

Driven by “Was there any loss of consciousness?”

Makes answers required
If “Was there any loss of consciousness?” is Yes, “How long, as near as known” becomes required before the form can be submitted.

Driven by “Is the athlete under 18?”

Makes answers required
If “Is the athlete under 18?” is Yes, “When a parent or guardian was told” becomes required before the form can be submitted.

Driven by “Has the athlete been assessed by a clinician?”

Makes answers required
If “Has the athlete been assessed by a clinician?” is Yes, “Clinician name and date assessed” becomes required before the form can be submitted.

Set it up step by step

1
Write it the same day
Details of how a head injury happened fade within hours, and this record is the one people rely on weeks later.
2
Keep signs and symptoms apart
What a coach saw and what the athlete said are different evidence, and combining them loses the part that matters clinically.
3
Record removal even when it went wrong
An honest note that an athlete was not removed immediately is what changes practice; a tidy record changes nothing.
4
Track stages with dates
Return to play is a sequence with sign-offs. Listing stages without dates lets an athlete skip one without anyone noticing.

Mistakes to avoid

Waiting for a diagnosis before writing anything down, so the incident detail is lost.
Recording no parental contact time for a young athlete, which is the first thing questioned afterwards.
Clearing return to play on a coach's judgement when written clinical clearance was required.

What it pairs with

Most teams don't run this form on its own. These are the forms and systems it sits next to.

What to do with the responses

File the report with the athlete's record, ensure clinical assessment happens, work through the return-to-play stages with dated sign-offs, and keep the athlete out until written clearance.

Works in this layout

Browse classic templates

Forms that overlap this one

These pages cover the same subject ground as the concussion incident report, matched on the words people actually search for.

Privacy & compliance

This form collects health information. Keep access limited to the people who need it, turn on encrypted answers for the clinical questions, and set a retention window so records don't sit in the dashboard forever.

Frequently asked questions

Does this diagnose a concussion?

No. It records a suspected concussion, what was observed and what was done. Diagnosis and clearance come from a clinician.

Who should complete it?

Whoever was present, usually a coach or athletic trainer. A parent can add what they saw afterwards in the notes.

How is this different from a workplace incident report?

It is built around head injury in sport: signs versus symptoms, removal from play, parental notification and staged return to play.

What protocol should we follow?

The one set by your governing body and clinicians. This form records what happened and who signed off each stage, whatever protocol applies.

Is the Concussion Incident Report template free to use?

Yes. You can preview and test Concussion Incident Report on this page without an account, and take a copy into your own HelloForms workspace on the free plan. There is nothing to install and no card required to publish it.

What does the Concussion Incident Report template ask for?

It asks 29 questions across 2 pages, 21 of which are required. Every question is listed in full further down this page, and each one can be renamed, reordered, made optional or deleted after you copy the template.

Can I edit the Concussion Incident Report form after copying it?

Yes — the copy is entirely yours. Change wording, add or remove questions, switch between the classic layout, restyle it to match your brand, and set who gets notified on each submission.

How does the conditional logic in this sports & recreation form work?

4 conditional rules ship with the template: Features conditional validation: if “Was the athlete removed from play immediately?” is No, “Why they were not removed immediately” becomes mandatory before the form can be sent. Features conditional validation: if “Was there any loss of consciousness?” is Yes, “How long, as near as known” becomes mandatory before the form can be sent. Features conditional validation: if “Is the athlete under 18?” is Yes, “When a parent or guardian was told” becomes mandatory before the form can be sent. All rules are editable in the Logic tab.

Where do responses to the Concussion Incident Report form go?

Submissions land in your workspace under Submissions, where you can search, filter, label and export them to CSV or PDF. You can also email a notification to your team on every submission and send the respondent an auto-reply.

Can I embed the Concussion Incident Report form on my own website?

Yes. Publish the form and paste the embed snippet into any page or share the direct link. The embedded form resizes to fit its container and loads no advertising or marketing trackers inside the iframe.

Is the signature on this form legally usable?

The template captures a drawn signature and stores it with the submission, along with the timestamp, so you keep evidence of who agreed and when. Whether that is sufficient depends on your jurisdiction and the agreement itself.

More forms teams pair with the concussion incident report.

Related categories

All Sports & Recreation templates

Concussion Incident Report

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