UHSAA Concussion Return to Sport Clearance (Utah)

Utah law has required since 2011 that a child suspected of a concussion be removed from sports until evaluated by an appropriate health care provider, who must give written clearance. UHSAA's six-page packet, revised August 6, 2024, includes parent instructions, provider guidance, a graduated return-to-sport table, the clearance form and a return-to-school recommendations page.

Who completes it

The school representative fills in the student, school and injury details. The health care professional checks one of four outcomes, marks MD, DO, NP or PA and signs with license numbers; an athletic trainer or trained responsible adult signs when supervising the graduated protocol.

Submitting and payment

How to submit it
The parent returns the signed Concussion Return to Sport Clearance Form to the school before the student is allowed to return to sport.
Who pays
UHSAA sets no fee and the form does not say who pays for the evaluation.

Good to know

  • By signing, the provider certifies they are licensed, practicing within scope and completed a continuing education course in concussion evaluation and management within the past 3 years.
  • Stage 4 and beyond wait until the assessment battery (symptoms, cognitive testing, balance, gait, vestibular and oculomotor exam) has normalized.
  • If the student is not ready to return or advance, the provider should not fill out the clearance form and should give a separate written statement.
  • No student returns to contact activities until fully back at school without extra accommodations that were not already part of a 504 plan or IEP.

Get the official form

Download the current version from the source each time; forms change without notice.

UHSAA Concussion Instructions and Return to Sport Clearance Form

Fill it with Vero

If your copy of the form is a fillable PDF, upload it once and Vero Documents fills it from the visit note and the chart, ready for you to review and sign. Download, print, or email the finished form, with the patient’s consent.

How this list is checked

A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms and their requirements change without notice, so check the official page for the current version before you complete one.

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Frequently asked questions

Who can sign the UHSAA concussion clearance form?

A licensed health care professional practicing within their scope who has completed a continuing education course in concussion evaluation and management within 3 years. The form offers MD, DO, NP and PA checkboxes and asks for the provider's license and DOPL license numbers.

Can a student progress through return to sport before the final clearance?

Yes. One option lets the athlete advance through the protocol up to level 4 under school-designated personnel, with re-evaluation required before levels 5 and 6. Another releases a recovered athlete to complete the protocol monitored by an athletic trainer or trained responsible adult.

What return-to-sport steps does Utah use?

A six-step strategy adapted from the 6th International Conference on Concussion in Sport: symptom-limited activity, light then moderate aerobic exercise, individual sport-specific exercise, non-contact training drills, full contact practice and return to sport, each typically taking at least 24 hours.