Please note: the Safety Standards are currently being updated

Please note: the Safety Standards are currently being updated for late August 2025. As a result, some of the content on OPASSE may not be up to date. Contact Ask Ophea at safety@ophea.net if you would like copies of specific activity pages from the 2024-2025 year.

View/Print PDF

Sample Return to School Plan – Stages 4 to 6 Form

General Information

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 (i.e., 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 medical doctor or 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 (i.e., completed Return to Learn (RTL) – Stage 4) and
  • are medically cleared by a medical doctor or nurse practitioner.

Principal/Designate

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

Parents/Guardians

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

Parents/Guardians

The student is ready to progress to RTPA – Stage 5.
Parent/Guardian Signature:
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 physical education class, 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.

If a student is participating in physical education and/or non-competitive intramural activities

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.
Principal/Designate Signature:
Date:
Comments:
Parent/Guardian Signature:
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.
Principal/Designate Signature:
Date:
Comments:

Parents/Guardians

The student has completed the RTPA process.
Parent/Guardian Signature:
Date:
Comments: