Sample Concussion Symptom Awareness Tool
Instructions:
This tool has been developed to assist teachers with the tracking of a student’s symptoms throughout the Return to Learn process. The symptoms listed on this tool are the same as the symptoms used on the Sample Tool to Identify a Suspected Concussion.
The list below allows for the tracking of student progress over time. To use the Tool:
- Record the date the student goes through the list of symptoms
- Record the stage of the Return to Learn and Return to Physical Activity the student is in
- Check the corresponding box of the concussion-related symptom the student is experiencing
- Based on the concussion-related symptoms checked – review the Sample Strategies and/or Approaches for Students tool to assist with programming for the student.
Student Name:
Date:
Stage:
Physical
Headaches
Dizziness
Fatigue or low energy (sleeping more or less than usual)
Vision problems (sensitivity to lights)
Noise sensitivity, hearing issues causing irritability (gymnasiums, music)
Social/Emotional/Behaviour
More irritable in the classroom
Feeling anxious or nervous
Easily overwhelmed by school requirements or activities
Feeling depressed or withdrawn
Cognitive – Communication
Difficulty concentrating and/or remembering (e.g., asks for things to be repeated)
Feeling slowed down, slow to process information (verbally or written)
Challenges with classroom tasks and language (e.g., managing workload, word finding, naming, vocabulary)
Unable to attend to task completion