ImPACT Baseline Concussion Testing
Documents, Information & FAQs
(Return to Play & Acknowledgement Form)
Concussion Management, Recognition & Prevention
On June 25, 2012, the Board of School Directors approved Board Policy No. 123.1 - "Management of Concussions" as part of its continued effort to promote the safety, health and well-being of students who participate in athletic contests and competitions. Policy 123.1 seeks to increase awareness of the serious nature and consequences of concussions, head trauma and other athletic-related injuries, and establish standards and requirements for the management and care of such injuries and return to play decisions. To view, the concussion policy click here.
Concussion Recognition Info & Mandatory Acknowledgment Form
Pursuant to Policy 123.1 and Pennsylvania's Safety in Youth Sports Act, all students who participate in or desire to participate in an athletic activity must be provided with information describing the nature and risk of concussions and traumatic brain injuries, and the risks associated with continuing to play or practice after suffering a concussion or traumatic brain injury. This information was included with your annual physical forms. It can also be downloaded for viewing and printing here: Concussion Information & Acknowledgement Form
All students desiring to participate in an athletic activity are required to sign and return the form acknowledging receipt of this information to their coach, sponsor or the Athletic Office (page 4 of the document).
The Acknowledgement Form must be signed by both the student & his/her parent/guardian. No student shall be permitted to practice, play or participate in a sport/athletic activity until the completed & signed form has been returned.
Suspected Injuries & Return to Play
Any student who sustains a suspected or confirmed concussion will be removed from play, and will not be permitted to return to participation unless and until the student has been evaluated by and been issued a written release to return to play by a licensed physician trained in the evaluation and management of concussions, or other appropriate medical professional, as such term in defined in Policy 123.1 and the Safety in Youth Sports Act.
A copy of the Return to Release Form must be completed by the appropriate medical professional and returned to the coach, sponsor and Athletic Office prior to being permitted to return to play can be downloaded here: Return to Play Release Form.
In addition, the parents/guardians of a student who sustains a suspected or confirmed concussion will again be provided with a copy of the concussion information sheet, and will have to again acknowledge its receipt by signing the Acknowledgment form (page 4 of the document) and returning it to the Athletic Office: Concussion Information & Acknowledgement Form
Additional information regarding the importance of recognizing the signs and symptoms of concussions and other brain injuries is available for review on the websites of the Centers for Disease Control and the Pennsylvania Department of Health, which you can link to here:
To view the Pine-Richland Concussion Management policy click here.
Pine-Richland School District will provide ImPACT baseline concussion testing, through UPMC, for students who participate in interscholastic PIAA/WPIAL-sanctioned sports. Based on recommendations from ImPACT and the UPMC Sports Concussion Program, ImPACT testing will be performed on a bi-yearly basis beginning in the 7th grade. Please contact the Athletic Office or the Athletic Trainers at 724-625-4444 ext. 6800 or 6825 for additional information about ImPACT testing and testing dates.
For more information about sports physicals, click here.
Other Sources for Baseline Testing
The Pittsburgh Penguins Foundation and UPMC Sports Medicine are expanding their free baseline concussion testing program to include youth athletes in all sports.
On a first-come, first-served basis, an expanded schedule of testing for athletes ages 10 to 14 will be available June 18 through Aug. 3 at four Community College of Allegheny County locations: Boyce, North, South and the West Hills Center.
Testing also is available at the UPMC Center for Sports Medicine on the South Side. Testing will also be provided through this program, for a small fee, to athletes who are 15 years of age and older or under 10 years of age.
For additional information about this program, please go to http://www.
pittsburghpenguinsfoundation.or you may register for a baseline test directly at http://www.upmc.com/ org/programs/headsup.html BaselineTesting.#Other Documents
2017-2018 Sports Physical Packet
Return to Play Release Form
Safety in Youth Sports FAQs
Recognizing Signs of Concussion
Concussion Information & Acknowledgement Form