Concussion Procedures


The Melrose School Committee adopted a policy (#5709) to address the identification and proper handling of suspected head injury in students participating in school-based athletics and marching band in accordance with Mass. Gen. L. c. 111, Section 222 (“Section 222”) and accompanying regulations (105 CMR 201. et seq.) (“Regulations”). These procedures serve to define the roles and responsibilities of staff, as well as, inform parents and community members of the role they play and their responsibilities in addressing reality of concussions in sports related head injuries.


The definitions of terms used herein are set forth in the Regulations at 105 CMR 201.005. The following are selected for reprinting here:

Department means the Massachusetts Department of Public Health.

Concussion means a complex disturbance in the brain function due to direct or indirect trauma to the head, related to neurometabolic dysfunction, rather than structural injury.

Head Injury means a direct or indirect trauma to the head including a concussion or traumatic brain injury.

Second impact syndrome means a potentially lethal condition that can occur when a person sustains a head injury prior to the complete healing of a previous brain injury causing deregulation of cerebral blood flow with subsequent vascular engorgement.

Traumatic Brain Injury (TBI) means a complex pathophysiological process affecting the brain, induced by traumatic biomechanical forces. TBI may be caused either by a direct blow to the head, face, neck or elsewhere on the body with an impulsive force transmitted to the head. TBI includes, but is not limited to, a concussion.

Roles and Responsibilities

The Athletic Director, under the Supervision of the Superintendent, shall be responsible for the general implementation of these procedures as it relates to students in grades 6 through 12 who participate in extracurricular athletic activities and/or marching band.

Coaches are required to instruct students in form, technique and skills that minimize sports-related head injury and are directed to discourage and prohibit students from engaging in any unreasonably dangerous athletic technique that endangers the health and safety of a student, including using a helmet or any other sports equipment as a weapon.

Students who engage in unreasonably dangerous behavior while participating in extracurricular athletic activities may be excluded from the privilege of participating in extracurricular athletic activities and, further, may be subject to disciplinary consequences in accordance with the code of


The following personnel, both those employed and those serving in a volunteer capacity, shall be required to participate in an annual training in the prevention and recognition of a sports-related head injury, including second impact syndrome: coaches, certified athletic trainers, school physicians, school nurses, Athletic Director, and marching band directors. In addition, students who participate in an extracurricular athletic activity and their parents shall be required to participate in such training annually.

In accordance with Section 222 and the Regulations at 105 CMR 201.008, online training programs will be offered through the Department at no charge to the individual. Individuals who are required to participate in the training shall submit documentation verifying the completion of the training either on line or by another approved method to the [Superintendent/AD?]. Such documentation shall be maintained by the Superintendent or his designee for at least three years.

Prerequisites to Participation in Student Athletics [or Marching Band]

At or before the start of each sport or band season, students/ parents shall provide the following to the Athletic Director or his/her designee:

1. Documentation of the student’s annual physical examination;

2. A completed form for Pre-Participation Head Injury/ Concussion Reporting For Extra-curricular Activities (“Pre-Participation Form”) which shall include:

a. A comprehensive history with up-to-date information relative to concussion history, any history regarding head, face or cervical spine injury and/or any history of co-existent concussion injuries; and

b. Signatures of both the parent and the student.

3. A certification of completion for any Department approved course or a signed acknowledgment as to their receipt and review of Department approved written materials. The certification is valid for one school year.

If the student/ parent has not provided the above documentation, the student will not be permitted to participate in the activity, including but not limited to try-outs or practices.

Removal due to Head Injury and Procedures for Returning to the Activity

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 practice or competition that day. The student must provide a completed Department Post Sports-Related Head Injury Medial Clearance and Authorization Form to the Athletic Director prior to any resumption of participation in an extracurricular athletic activity.

If a student is diagnosed with a concussion, school personnel, including but not limited to teachers, school nurse, and certified athletic trainer, along with parents shall develop a written graduated entry plan for return to full academics and extracurricular activities. Accommodations, may include, as appropriate: provision for physical or cognitive rest; graduated return to classroom studies; estimated time intervals for resuming activities; assessments by the school nurse; periodic medical assessment by a physician until the student is authorized to full classroom and extracurricular activities. The school physician and/or student’s physician may be consulted as appropriate in devising the graduated entry plan.

Reporting Requirements

The Athletic Director shall disseminate to coaches and band directors copies of the Pre-participation Form for all of that coach’s team or band director’s band members. The Athletic Director shall ensure that the nurse receives a copy and reviews any forms that indicate a history of head injury, with review by the school physician and certified athletic trainer if appropriate The Athletic Director shall also ensure proper dissemination and review of reports relating to head injury during the sports season.

All coaches are required to report any circumstances in which the student was removed from play for suspected head injury, suspected concussion, or loss of consciousness and the nature of the suspected injury to the student’s parent in person or by telephone immediately after the competition or practice, with written confirmation to the parent by paper or electronic format no later than the end of the next business day. The coach must also notify the Athletic Director and school nurse of the removal from play and the nature of the suspected injury no later than the end of the next business day. The coach must also complete a Department Report of Head Injury During Sports Season Form and provide it to the Athletic Director, parent, certified athletic trainer and school nurse.

All parents are required to complete and submit Department Report of Head Injury During Sports Season Form to the athletic director if a student sustains a head injury outside of the extracurricular activity.

Publication and Consequences

The portions of these procedures relevant to students shall be published annually in the student handbook.

No student will be permitted to participate in an extracurricular athletic activity unless the student and his/her parents have complied with their obligations under these procedures. Failure of staff to adhere to the requirements herein may result in disciplinary action.

Cross Ref: Mass. Gen. L. CH. 111, Section 222 105 CMR 201.000 et seq.
Related Forms

  • Pre-Participation Head Injury/ Concussion Reporting For Sports and Extra-Curricular Activities
  • MHS/MVMMS Return to Play Considerations
  • MHS/MVMMS Home Instructions
  • MHS/MVMMS Information for Treating Physician
  • MHS/MVMMS Authorization for Release of Medical Information
  • MHS/MVMMS Concussion Reporting
  • MHS/MVMMS Concussion Management Protocol Return to Play
  • Department Post Sports-Related Head Injury Medial Clearance and Authorization

    Sample Letters

  • Letter from Athletic Trainer
  • Letter Explaining Concussion symptoms
  • MHS Guidance Letter
  • MVMMS Guidance Letter

PDF Document with Procedures, Forms and Sample Letters: