When can a player with a concussion return to hockey, and what paperwork do I need?

Under the Hockey Canada Concussion Protocol (effective May 6, 2025), a player diagnosed with a concussion is managed under the supervision of a medical doctor or nurse practitioner using the Return-to-School Strategy (if applicable) and the Hockey-Specific Return-to-Sport Strategy. The two begin at the same time and the first step is the same.

Rules for the six steps:

• The player spends a minimum of 24 hours at each step.
• Symptoms may worsen slightly during steps 1 to 3 if the increase is mild (one to two points on a zero-to-10 scale) and brief (settling within 1 hour). If symptoms worsen more, the player stops and tries again the next day at the same step.
• Before step 4, the player must have completed all steps of the Return-to-School Strategy (if applicable) and must give their coach or safety person a Medical Clearance Letter (or traditional medical documentation) showing a medical doctor or nurse practitioner has personally evaluated them and cleared them for activities with risk of falls or contact. In rural, remote or northern areas, a nurse with pre-arranged access to a doctor or nurse practitioner can provide it.
• Step 4 is non-contact training drills with risk of inadvertent head impact; step 5 is all non-competitive activities and full-contact practice; step 6 is unrestricted sport and physical activity (Medical Clearance Letter).
• If symptoms return during steps 4 to 6, the player returns to step 3 until symptoms fully resolve, and medical clearance is needed again before step 4.

Documents: a player who is assessed and found not to have a concussion should get a Medical Assessment Letter (or traditional documentation) and can return without restriction. The letter contains personal health information, so the player or their parent or guardian provides it to the coach or safety person. The Hockey Alberta job description also has the safety person coordinate return to play and document all return to play steps.

Persisting symptoms: most players recover within four weeks; about 15 to 30 per cent have symptoms longer than that and may benefit from specialized interdisciplinary care.

Sources: https://cdn.hockeycanada.ca/hockey-canada/Hockey-Programs/Safety/Concussion/Downloads/hc-concussion-protocol-e.pdf and https://cdn.hockeycanada.ca/hockey-canada/Hockey-Programs/Safety/Concussion/Downloads/hc-medical-clearance-letter-e.pdf and