Head Injury Tracker (HIT) Project School Application Form
School Name *
School Address *
Contact Person *
Title *
Email *
Contact Phone Number *
Is Your School Public or Private *
Do you use either the ImPACT or SCAT5 symptom checklist for your initial evaluation *
Who will be entering the HIT data at school? *
The Massachusetts Concussion Management Coalition (MCMC) seeks to promote a shared commitment to best practices regarding concussion treatment and return to play (RTP) guidelines. The MCMC’s information and guidelines are not intended as a standard of care and should not be interpreted as such. Information from MCMC is only a guide and is of a general nature consistent with the reasonable practice of a healthcare professional. Individual treatment will depend on the facts and circumstances specific to each individual case and remain the sole responsibility of the health care provider(s). MCMC supports the perspective on RTP decisions and patient care responsibility set forth in what is commonly referred to as the Berlin Report, October 2016, which is available in its entirety on our website.
HIT Expectations
All schools under the Massachusetts Concussion Management Coalition (MCMC) umbrella are at the forefront of the movement for consistent treatment of mild traumatic brain injuries, more commonly known as concussions. However, this comes with certain obligations that will not only make your school’s program the best it can be, but also assures that your school is setting a good example for those that may want to join in later years. Outlined below are the expectations that MCMC’s schools are required to agree to in order to become part of the program.

Please read over the expectations carefully. By signing this form, you are agreeing to the conditions. The signature of the principal or the athletic director is required on the bottom.

1. I agree to offer enrollment in the HIT Project to all students who sustain a concussion in my school.

2. I agree to comply with state law that governs concussion management in my state.

3. I support MCMC’s goals for raising awareness for concussion management to reduce concussions, post-concussion syndrome, and second impact syndrome through education and unified best practices.

Name and Title *
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