Safety Reporting Forms


In 2023, USA Hockey and Wisconsin Amateur Hockey Association established a Concussion Management Program in accordance with Wisconsin State law as amended to include Wisconsin Act 172 relating to concussions and other head injuries sustained in youth athletic activities. The Wisconsin Amateur Hockey Association is requiring all member clubs to comply with the WAHA program and Wisconsin state law.

To be in compliance with the new law, all Sauk Prairie Youth Hockey Association parents, skaters and coaches should take the time to learn the importance of recognizing and responding to the signs, symptoms, and behaviors of a concussion or head injury. 

suspected concussion reporting

SPYHA takes concussions very seriously and has adopted USA Hockey’s Concussion

Management Program in an effort to comply with both national and state regulations regarding concussion management. If in doubt, err on the side of caution and submit a report for a suspected concussion.

Parents should understand both the USAH Concussion Management Program and the Wisconsin Act 172 pertaining to concussions. During registration, parents are required to acknowledge their understanding of the concussion rules and the steps SPYHA, its coaches, and the parents/guardians must take if a concussion is suspected as part of the registration process. 

In the case of a suspected concussion by a coach, or one diagnosed by a physician, the player will not be allowed to return to the ice per Wisconsin law. The skater is required to seek medical attention and will not be allowed to play or practice with the team until medical clearance is obtained.

what is a concussion?

A concussion is a type of traumatic brain injury that interferes with normal functioning of the brain (changes how the cells in the brain normally work). A concussion can be caused by a bump, blow, or jolt to the head or body. Basically, any force that is transmitted to the head causing the brain to literally bounce around or twist within the skull can result in a concussion. Over 90% of concussions do not involve loss of consciousness. It is important to note that a concussion can happen to anyone in any sport or athletic activity. Concussions affect people in four areas of function:

  • Physical – This describes how a person may feel: headache, fatigue, nausea, vomiting, dizziness, etc. Children might describe this as seeing stars or having sensitivity to light and noise.
  • Thinking – Poor memory and concentration, responds to questions more slowly, asks repetitive questions. Concussion can cause an altered state of awareness. Children might say they’re having brain fog or feeling spacey and slow.
  • Emotions – A concussion can make a person more irritable and cause mood swings.
  • Sleep – Concussions frequently cause changes in sleeping patterns, which can increase fatigue.

Suspected concussion reporting Checklist

  1. In the event of a suspected concussion, the Coach and/or Parent should complete the SPYHA Concussion Symptoms Form and submit to the SPYHA Safety Officer. The form can be completed in one of two ways:
  2. SPYHA Concussion Symptoms Online Form or automatically submits to the SPYHA Safety Officer when you click submit. 
  3. SPYHA Concussion Symptoms PDF Form – attach a copy of the completed paper form in an email and send to SYPHA Safety Officer at
  4. The injured player must be evaluated by healthcare provider with experience in pediatric concussion management.
  5. Please contact SPYHA Safety Officer if further assistance is required. (
  6. Once player has been evaluated, send written clearance notice from the health care provider to SPYHA Safety Officer at
  7. SPYHA Safety Officer will then inform the SPYHA Board and head coach that player may return to play and relay any necessary restrictions as outlined by the medical professional.  


It is the policy of SPYHA that any injury requiring the medical attention of a physician that prohibits the player from playing the game or practice of any duration will require the physician to sign a return to play release allowing the injured player to return to the ice to play or practice the game of hockey.

The release will give the date at which they are allowed to return and must be signed by the treating physician. Any guidelines or limitations that the physician requires regarding the return of the player must be outlined on the signed release form. 

Injury reporting/return to play checklist (non-concussion)

1.     In the event of a non-concussion injury, the player’s parent should complete the SPYHA Injury Reporting Form and submit to the SPYHA Safety Officer. This is an online form that upon completion will automatically notify the SPYHA Safety Officer.

2.     Once player has received written clearance notice from their health care provider, please email a copy of the release with any return to play limitations to SPYHA Safety Officer at

3.     SPYHA Safety Officer will then inform the SPYHA Board and head coach that player may return to play and relay any necessary restrictions as outlined by the medical professional.  

safety quick links

Safety Officer

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