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< % f > j j 0 "k #g 2 p % p | Uj p Uj 8 $ $ % $ $ $ $ $ j j % $ $ $ "k $ $ $ $ p $ $ $ $ $ $ $ $ $ * : Appendix A
Concussions Education Programs and Policies Survey
PART A: General Information
1. Approximately how many students (between grades 9-12) attend your school?
PRIVATE "" MACROBUTTON HTMLDirect <600
PRIVATE "" MACROBUTTON HTMLDirect 600-800
PRIVATE "" MACROBUTTON HTMLDirect 800-1000
PRIVATE "1000\">" MACROBUTTON HTMLDirect >1000
2. Prior to receiving this survey, has the TDSB informed you about the Ontario Ministry of Education Policy/ Program Memorandum on Concussions (PPM-158)?
PRIVATE "" MACROBUTTON HTMLDirect Yes
PRIVATE "" MACROBUTTON HTMLDirect No
PART B: Student Concussion Education
The following questions relate to your schools current concussion education program (as of Feb 1, 2015).
3. Do high school students at your school receive any concussion education?
PRIVATE "" MACROBUTTON HTMLDirect Yes
PRIVATE "" MACROBUTTON HTMLDirect No
4. Which students at your school receive concussion education? (Please check all that apply)
PRIVATE "" MACROBUTTON HTMLDirect Students do not receive concussion education.
PRIVATE "" MACROBUTTON HTMLDirect All students.
PRIVATE "" MACROBUTTON HTMLDirect Students enrolled in a physical education/gym class.
PRIVATE "" MACROBUTTON HTMLDirect Student athletes participating in TDSSAA (Toronto District Secondary SchoolsAthletic Association) teams.
PRIVATE "" MACROBUTTON HTMLDirect Student athletes participating in high risk (eg. football, rugby and hockey)TDSSAA teams.
PRIVATE "" MACROBUTTON HTMLDirect Other: PRIVATE "" MACROBUTTON HTMLDirect
5. Students in which of the following grades will receive concussion education? (Please check all that apply)
PRIVATE "" MACROBUTTON HTMLDirect Students do not receive concussion education.
PRIVATE "" MACROBUTTON HTMLDirect 9
PRIVATE "" MACROBUTTON HTMLDirect 10
PRIVATE "" MACROBUTTON HTMLDirect 11
PRIVATE "" MACROBUTTON HTMLDirect 12
PRIVATE "" MACROBUTTON HTMLDirect Student athletes participating in TDSSAA teams.
PRIVATE "" MACROBUTTON HTMLDirect Student athletes participating in high risk (eg. football, rugby and hockey) TDSSAA teams.
6. Who delivers the concussion education program to students? (Please check all that apply)
PRIVATE "" MACROBUTTON HTMLDirect Our school does not have a concussion education program for students.
PRIVATE "" MACROBUTTON HTMLDirect Physical and health educator
PRIVATE "" MACROBUTTON HTMLDirect Teacher coach
PRIVATE "" MACROBUTTON HTMLDirect Other: PRIVATE "" MACROBUTTON HTMLDirect
7. Do students receive education on the details of a return to play protocol?
PRIVATE "" MACROBUTTON HTMLDirect Yes
PRIVATE "" MACROBUTTON HTMLDirect No
PRIVATE "" MACROBUTTON HTMLDirect I don't know.
8. Do students receive education on the details of a return to learn protocol?
PRIVATE "" MACROBUTTON HTMLDirect Yes
PRIVATE "" MACROBUTTON HTMLDirect No
PRIVATE "" MACROBUTTON HTMLDirect I don't know.
9. Prior to January 30, 2015 did students at your school receive concussion education? (Please check all that apply)
PRIVATE "" MACROBUTTON HTMLDirect Yes, all students received concussion education.
PRIVATE "" MACROBUTTON HTMLDirect Yes, students enrolled in a physical education/gym class received concussion education.
PRIVATE "" MACROBUTTON HTMLDirect Yes, student athletes participating in TDSSAA teams received concussion education.
PRIVATE "" MACROBUTTON HTMLDirect Yes, student athletes participating in high risk (eg. football, rugby and hockey)TDSSAA teams received concussion education.
PRIVATE "" MACROBUTTON HTMLDirect No, students did not receive concussion education.
PRIVATE "" MACROBUTTON HTMLDirect I don't know.
PRIVATE "" MACROBUTTON HTMLDirect Other: PRIVATE "" MACROBUTTON HTMLDirect
If you answered Yes to question 9, could you please explain the details of this education program and how it compares to the current program you have as of Feb 1?
PRIVATE "" MACROBUTTON HTMLDirect
PART C: School Concussion Protocol
The following questions relate to your schools current concussion protocol (as of Feb 1, 2015).
10. Does your school have a formal concussion/injury tracking system to track the incidence and progress of concussed students?
PRIVATE "" MACROBUTTON HTMLDirect Yes
PRIVATE "" MACROBUTTON HTMLDirect No
11. Does your school currently have a formal protocol for managing students who experienced a concussion?
PRIVATE "" MACROBUTTON HTMLDirect Yes
PRIVATE "" MACROBUTTON HTMLDirect No
PRIVATE "" MACROBUTTON HTMLDirect Other: PRIVATE "" MACROBUTTON HTMLDirect
12. Who is in charge of the "return to play" protocol at your school? (Please only select one option)
PRIVATE "" MACROBUTTON HTMLDirect Our school does not have a return to play protocol.
PRIVATE "" MACROBUTTON HTMLDirect School principal
PRIVATE "" MACROBUTTON HTMLDirect School vice principal
PRIVATE "" MACROBUTTON HTMLDirect Guidance counselor
PRIVATE "" MACROBUTTON HTMLDirect Physical and health educator
PRIVATE "" MACROBUTTON HTMLDirect Teacher coach
PRIVATE "" MACROBUTTON HTMLDirect Parent
PRIVATE "" MACROBUTTON HTMLDirect Other: PRIVATE "" MACROBUTTON HTMLDirect
Comments:
PRIVATE "" MACROBUTTON HTMLDirect
13. Who is involved in monitoring the students progress through the "return to play" protocol? (Please check all that apply)
PRIVATE "" MACROBUTTON HTMLDirect Our school does not have a return to play protocol.
PRIVATE "" MACROBUTTON HTMLDirect School principal
PRIVATE "" MACROBUTTON HTMLDirect School vice principal
PRIVATE "" MACROBUTTON HTMLDirect Guidance counselor
PRIVATE "" MACROBUTTON HTMLDirect Physical and health educator
PRIVATE "" MACROBUTTON HTMLDirect Teacher coach
PRIVATE "" MACROBUTTON HTMLDirect All teachers of the student
PRIVATE "" MACROBUTTON HTMLDirect Parent
PRIVATE "" MACROBUTTON HTMLDirect Other: PRIVATE "" MACROBUTTON HTMLDirect
Comments:
PRIVATE "" MACROBUTTON HTMLDirect
14. Who is in charge of the "return to learn" protocol at your school? (Please only select one option)
PRIVATE "" MACROBUTTON HTMLDirect Our school does not have a return to learn protocol.
PRIVATE "" MACROBUTTON HTMLDirect School principal
School vice principal
PRIVATE "" MACROBUTTON HTMLDirect Guidance counselor
PRIVATE "" MACROBUTTON HTMLDirect Physical and health educator
PRIVATE "" MACROBUTTON HTMLDirect Teacher coach
PRIVATE "" MACROBUTTON HTMLDirect Parent
PRIVATE "" MACROBUTTON HTMLDirect Other: PRIVATE "" MACROBUTTON HTMLDirect
Comments:
PRIVATE "" MACROBUTTON HTMLDirect
15. Who is involved in monitoring the students progress through the "return to learn" protocol? (Please check all that apply)
PRIVATE "" MACROBUTTON HTMLDirect Our school does not have a return to learn protocol.
PRIVATE "" MACROBUTTON HTMLDirect School principal
PRIVATE "" MACROBUTTON HTMLDirect School vice principal
PRIVATE "" MACROBUTTON HTMLDirect Guidance counselor
PRIVATE "" MACROBUTTON HTMLDirect Physical and health educator
PRIVATE "" MACROBUTTON HTMLDirect Teacher coach
PRIVATE "" MACROBUTTON HTMLDirect All teachers of the student
PRIVATE "" MACROBUTTON HTMLDirect Parent
PRIVATE "" MACROBUTTON HTMLDirect Other: PRIVATE "" MACROBUTTON HTMLDirect
Comments:
PRIVATE "" MACROBUTTON HTMLDirect
16. Prior to Jan 30 2015, did your school have a formal protocol for managing students who experienced a concussion? (Please check all that apply)
PRIVATE "" MACROBUTTON HTMLDirect Yes, our school had a return to play protocol.
PRIVATE "" MACROBUTTON HTMLDirect Yes, our school had a return to learn protocol.
PRIVATE "" MACROBUTTON HTMLDirect No, our school did not have a formal management protocol.
PRIVATE "" MACROBUTTON HTMLDirect I dont know.
PRIVATE "" MACROBUTTON HTMLDirect Other: PRIVATE "" MACROBUTTON HTMLDirect
PART D: Staff Concussion Training
The following questions relate to your schools current staff training on concussions (as of Feb 1, 2015).
17. Are staff at your high school recommended to complete any concussion training? (Please check all that apply).
PRIVATE "" MACROBUTTON HTMLDirect Yes, all staff receive concussion training.
PRIVATE "" MACROBUTTON HTMLDirect Yes, physical and health educators receive concussion training.
PRIVATE "" MACROBUTTON HTMLDirect Yes, teacher coaches of TDSSAA teams receive concussion training.
PRIVATE "" MACROBUTTON HTMLDirect Yes, teacher coaches of high risk (i.e. football, rugby and hockey) TDSSAA teams receive concussion training.
PRIVATE "" MACROBUTTON HTMLDirect Yes, school administrators receive concussion training.
PRIVATE "" MACROBUTTON HTMLDirect No, staff do not receive any concussion training.
PRIVATE "" MACROBUTTON HTMLDirect Other: PRIVATE "" MACROBUTTON HTMLDirect
18. Are you aware that the Parachute Canada Online Concussion Course is available for staff at your school to learn more about concussions?
PRIVATE "" MACROBUTTON HTMLDirect Yes
PRIVATE "" MACROBUTTON HTMLDirect No
19. Do you know if any staff at your school have taken/are currently taking the Parachute Canada Online Concussion Course. (Please check all that apply)
PRIVATE "" MACROBUTTON HTMLDirect Yes, all staff have taken/are currently taking this course.
PRIVATE "" MACROBUTTON HTMLDirect Yes, physical and health educators have taken/are taking this course.
PRIVATE "" MACROBUTTON HTMLDirect Yes, teacher coaches of TDSSAA teams have taken/are taking this course.
PRIVATE "" MACROBUTTON HTMLDirect Yes, teacher coaches of high risk (i.e. football, rugby and hockey) TDSSAA teams have taken/are taking this course.
PRIVATE "" MACROBUTTON HTMLDirect Yes, school administrators have taken/are taking this course.
PRIVATE "" MACROBUTTON HTMLDirect No, staff at my school have not taken/are not taking this course.
PRIVATE "" MACROBUTTON HTMLDirect I dont know.
PRIVATE "" MACROBUTTON HTMLDirect Other: PRIVATE "" MACROBUTTON HTMLDirect
20. Prior to Jan 30, 2015, were staff at your high school recommended to complete any concussion training? (Please check all that apply)
PRIVATE "" MACROBUTTON HTMLDirect Yes, all staff received concussion training.
PRIVATE "" MACROBUTTON HTMLDirect Yes, physical and health educators received concussion training.
PRIVATE "" MACROBUTTON HTMLDirect Yes, teacher coaches of TDSSAA teams received concussion training.
PRIVATE "" MACROBUTTON HTMLDirect Yes, teacher coaches of high risk (i.e. football, rugby and hockey) TDSSAA teams received concussion training.
PRIVATE "" MACROBUTTON HTMLDirect Yes, school administrators received concussion training.
PRIVATE "" MACROBUTTON HTMLDirect No, staff were not required to receive concussion training.
PRIVATE "" MACROBUTTON HTMLDirect I dont know.
PRIVATE "" MACROBUTTON HTMLDirect Other: PRIVATE "" MACROBUTTON HTMLDirect
PART E: Parent Concussion Education
The following questions relate to parent concussion education at your school (as of Feb 1, 2015).
21. Do parents at your high school have an opportunity to receive concussion education? (Please check all that apply)
PRIVATE "" MACROBUTTON HTMLDirect Yes, all parents receive concussion education.
PRIVATE "" MACROBUTTON HTMLDirect Yes, parents of students who are enrolled in a physical education/gym class receive concussion education.
PRIVATE "" MACROBUTTON HTMLDirect Yes, parents of students who participate in TDSSAA teams receive concussion education.
PRIVATE "" MACROBUTTON HTMLDirect Yes, parents of students who participate in high risk (i.e. football, rugby and hockey) TDSSAA teams receive concussion education.
PRIVATE "" MACROBUTTON HTMLDirect No, parents do not receive concussion education.
PRIVATE "" MACROBUTTON HTMLDirect Other: PRIVATE "" MACROBUTTON HTMLDirect
22. How is concussion education delivered to parents of students at your school? (Please check all that apply)
PRIVATE "" MACROBUTTON HTMLDirect Parents do not receive concussion education.
PRIVATE "" MACROBUTTON HTMLDirect Parents receive a copy of the Parachute Canada Concussion Guidelines for Parents/Caregivers.
PRIVATE "" MACROBUTTON HTMLDirect Parents receive a link to an online video on concussions.
PRIVATE "" MACROBUTTON HTMLDirect Parents are encouraged to attend Board-wide information nights on concussions.
PRIVATE "" MACROBUTTON HTMLDirect Other: PRIVATE "" MACROBUTTON HTMLDirect
23. Prior to Jan 30, 2015 did parents at your high school have an opportunity to receive concussion education? (Please check all that apply)
PRIVATE "" MACROBUTTON HTMLDirect Yes, all parents received concussion education.
PRIVATE "" MACROBUTTON HTMLDirect Yes, parents of students who were enrolled in a physical education/gym class received concussion education.
PRIVATE "" MACROBUTTON HTMLDirect Yes, parents of students who participated in TDSSAA teams received concussion education.
PRIVATE "" MACROBUTTON HTMLDirect Yes, parents of students who participated in high risk (i.e. football, rugby and hockey) TDSSAA teams received concussion education.
PRIVATE "" MACROBUTTON HTMLDirect No, parents did not receive concussion education.
PRIVATE "" MACROBUTTON HTMLDirect I dont know.
PRIVATE "" MACROBUTTON HTMLDirect Other: PRIVATE "" MACROBUTTON HTMLDirect
PART F: General PPM Questions
24. Are you aware that the following resources are available for your school to use in delivering a concussion education program/protocol?
YesNoThe Grade 9 Concussion Education Resource developed by the TDSBThe Ontario Physical and Health Education Association (OPHEA) online safety guidelines on concussionsThe online Concussion Tool: For Coaches, Teachers, Parents, Students and Athletic Therapists developed by Concussions OntarioParachute Canada/ThinkFirst website and/or videosThe Canadian Association for Coaches (CAC) concussion eLearning videos
25. To what extent do you agree with the following statement: "My school has received ample support from the PPM/TDSB to ..."
Strongly DisagreeDisagreeNeutralAgreeStrongly Agreedevelop a student concussion education program.implement a concussion protocol.educate staff on concussions.provide concussion education to parents.
26. In addition to the resources already provided by the PPM/TDSB, are there any resources and/or supports that you think would help enhance the following aspects of your school's concussion policy?
YesNoStudent concussion education programConcussion protocolStaff training on concussionsParent concussion education
If you answered yes to any of the fields in question 26 could you please explain:
PRIVATE "" MACROBUTTON HTMLDirect
27. To what extent do you agree with the following statement: The PPM on concussions has helped improve student education on concussions.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
28. To what extent do you agree with the following statement: The PPM on concussions has helped students suffering symptoms of a concussion receive the appropriate accommodations to meet their learning goals.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
29. Approximately, how many students in your school had a concussion last year (either in school or out of school)?
PRIVATE "" MACROBUTTON HTMLDirect None
PRIVATE "" MACROBUTTON HTMLDirect 1
PRIVATE "" MACROBUTTON HTMLDirect 2-5
PRIVATE "" MACROBUTTON HTMLDirect 5-10
PRIVATE "10\">" MACROBUTTON HTMLDirect >10
PRIVATE "" MACROBUTTON HTMLDirect I don't know.
If you have any additional comments or suggestions for enhancing concussion education, prevention, recognition and/or management at your school please let us know below:
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