1. RETURN TO SCHOOL PLAN
  2. RETURN TO LEARN/RETURN TO PHYSICAL ACTIVITIES STAGES 4-6
      1. Return to Learn
      2. Principal/Designate
      3. Parents/Guardians
      4. Return to Physical Activity
      5. Principal/Designate
      6. Parents/Guardians
      7. Principal/Designate
      8. Parents/Guardians
      9. Principal/Designate
      10. Parents/Guardians
      11. Principal/Designate
      12. Parents/Guardians

    alt

    RETURN TO SCHOOL PLAN

    Back to top



    RETURN TO LEARN/RETURN TO PHYSICAL ACTIVITIES STAGES 4-6

     

    During Stages 4, 5, or 6 (after medical clearance) a student’s concussion-related symptoms should not return. If they do, the student should return to Return to Physical Activity – Stage 3 (e.g., avoid any activity that puts the student at risk of falling or experiencing another impact to the head, neck, or body) and be reassessed by a physician/nurse practitioner.

     
    Student Name:
    Date:  



    Return to Learn

    Stage 4: Return to School Full-time without Accommodations Related to Concussion

    School Tracking: A student should not return to physical activities with a risk of contact until they have completely returned to school without accommodations (e.g., completed Return to Learn (RTL)-Stage 4 and are medically cleared by a physician/nurse practitioner.



    Principal/Designate

    The student has successfully completed the RTL Process.
    Signature of Principal/Designate:
    Date:
    Comments:  



    Parents/Guardians

    The student has successfully completed the RTL Process.
    Signature of Parents/Guardians:
    Date:
    Comments:  

    For students not participating in any physical activity at school this is the end of their Return to School process. Students participating in physical activity at school progress to Return to Physical Activity – Stage 4.



    Return to Physical Activity

    Stage 4: Skill Progression/Training Drills and Activities with Low Risk of Body Contact

    Goal: Adjust to usual intensity activity/exercise and add in more challenging skill progressions and multi-student activities/drills.

     

     

    Examples of activities at this stage:

    ·   Participation in components of physical activities in physical education class or intramural programs (including partner/group activities) with low-risk of body contact (e.g., multi-student passing activities/drills)

    ·   Avoid scrimmages, gameplay, and any activity that involves body contact (e.g., checking/tackling).

    School Tracking: A student can progress to RTPA – Stage 5 if they have spent a minimum of 24 hours at Stage 4 and activities at Stage 4 do not result in the return of concussion-related symptoms.



    Principal/Designate

    The student is ready to progress to RTPA – Stage 5.
    Signature of Principal/Designate:
    Date:
    Comments:  



    Parents/Guardians

    The student is ready to progress to RTPA – Stage 5.
    Signature of Parents/Guardians:
    Date:
    Comments:  

    Stage 5: Return to Non-Competitive Activities and Full Contact Practices

    Goal: Restore game-play confidence and physical and mental conditioning. Examples of activities at this stage:

    ·   Return to full participation in health and physical education classes, non-competitive intramural activities, and interschool practices (including contact drills, scrimmages).

    ·   Avoid competitions.

    School Tracking If a student is participating in physical education and/or intramurals at school this is the end of their Return to Physical Activity process. If a student is participating in interschool athletics, they will progress to Return to Physical Activity – Stage 6.

    A student can progress to RTPA – Stage 6 if: they have spent a minimum of 24 hours at Stage 5; and activities at Stage 5 do not result in the return of concussion-related symptoms.

     



    Principal/Designate

    The student has successfully completed the RTPA process.



    Parents/Guardians

    The student has successfully completed the RTPA process.

    If a student is participating in competitive intramural activities and/or interschool athletic competitions



    Principal/Designate

    The student is ready to progress to RTPA – Stage 6.

     



    Parents/Guardians

    The student is ready to progress to RTPA – Stage 6.
    Signature of Principal/Designate:
    Date:
    Comments:

     

     
    Signature of Parents/Guardians:
    Date:
    Comments:

     

       

    Stage 6: Return to All Competition without Restrictions

    School Tracking This is the end of the student’s Return to Physical Activity process.



    Principal/Designate

    The student has completed the RTPA process.
    Signature of Principal/Designate:
    Date:
    Comments:

       



    Parents/Guardians

    The student has completed the RTPA process.
    Signature of Parents/Guardians:
    Date:
    Comments:

       

    Back to top