Indiana High School Athletic Association, Inc



Indiana High School Athletic Association, Inc.

CONTEST OFFICIAL’S REPORT OF

REMOVAL OF PARTICIPANT DUE TO POTENTIAL CONCUSSION

A contest official shall complete this report when the official removes an athlete from a contest who exhibits signs, symptoms, or behaviors consistent with a concussion (such as loss of consciousness, headache, dizziness, confusion, or balance problems). This report shall immediately be e-mailed or faxed to the athletic director of the IHSAA member school where the athlete attends, but under no circumstance later than 24 hours after the conclusion of the contest.

|Date of Contest | |

|Name of Student Removed | |

|Number (if applicable) | |

|School of Student Removed | |

|Sport | |

|Opponent | |

|Name of Contest Official | |

Please send this report as an attachment to an e-mail or fax to the school’s athletic director. The link below will take you to the IHSAA school directory:



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