Jul 21, 2017
USA Hockey Pacific District
Serving Alaska, California, Hawaii, Nevada, Oregon and Washington

Pacific District Concussion Information Page

In April 2017, USA Hockey implemented a concussion awareness acknowledgement to its annual member registration

During online registration, each member will now read and accept the acknowledgement prior to completing the registration process.

In February 2017, the Pacific District implemented district-wide concussion protocols

This mandatory protocol is a key component of the Pacific District’s commitment to educating their membership - players, coaches, parents, managers, volunteers and leadership – about the importance of being able to recognize the symptoms of a concussion. The protocol includes an acknowledgement for coaches and parents/guardians as well as Return to Participation guidelines.

In addition, each state affiliate in the Pacific District has different legislation related to concussions in youth sports organizations. Learn more about what each state requires, and how and when the Pacific District protocol is implemented, here:

Player Safety Comes First!

We are all responsible for player safety. Recognizing a concussion is the first step to ensuring a complete recovery, and safe return to the ice.

Pacific District Concussion Protocol Forms

The Parent/Guardian Concussion Acknowledgement Form is a requirement for all registered athletes. The process (online or paper copy) may vary by affiliate.

The Parent/Guardian Concussion Acknowledgement Form:

The Parent/Guardian Concussion Acknowledgement Form is a requirement for all registered athletes. The process (online or paper copy) may vary by affiliate.

The Coach Concussion Acknowledgement Form:

The Coach Concussion Acknowledgement Form is a requirement for all coaches. The process (online or paper copy) may vary by affiliate.

The Concussion Clearance and Return to Play Form:

The Concussion Clearance and Return to Play Protocol form should be provided from a team manager to a parent or guardian each time an athlete is removed from participation for a concussion evaluation. This form can be provided to the medical professional treating the athlete, but most healthcare providers will use their own release forms as clearance to return to participation. Regardless, a medical clearance must be returned to the team manager (and kept in the athlete’s club records) once they are cleared to resume participation.

Click on the affiliate link below to access Concussion Protocol Forms:

Concussion Chronicles Newsletter, Articles and Athlete Stories

The Pacific District publishes an electronic newsletter to its membership, along with informative articles and athlete stories.

Educational Materials

For questions or more information, contact: PDConcussion@gmail.com