Workplace Concussion: What Safety Teams Should Know
Workplace Concussion: What Safety Teams Should Know
Recognize, Refer, Document, then support the return the provider sets
Recognize, Refer, Document, then support the return the provider sets
Sheldon Victorine, MS, ATC, CSCS
Published October 14, 2026
A workplace concussion is a mild traumatic brain injury that happens on the job, usually from a fall, a struck-by event or a vehicle crash. It often looks minor at the scene, and symptoms can show up later. The safety team’s job is to recognize a possible concussion at work, refer the worker to a health care provider, document what happened, and then support the return to work that the provider sets. This guide covers each of those steps.
Educational content for workplace safety teams. It is not medical advice and does not replace evaluation by a licensed health care professional.
A workplace concussion is a mild traumatic brain injury that happens on the job, usually from a fall, a struck-by event or a vehicle crash. It often looks minor at the scene, and symptoms can show up later. The safety team’s job is to recognize a possible concussion at work, refer the worker to a health care provider, document what happened, and then support the return to work that the provider sets. This guide covers each of those steps.
Educational content for workplace safety teams. It is not medical advice and does not replace evaluation by a licensed health care professional.
Key takeaways
A workplace concussion often looks minor at the scene and symptoms can show up later.
On site the team’s job is to recognize a possible concussion and refer, not to reach a verdict.
Diagnosis is always a health care provider’s job; return to work is the treating provider’s call.
Document facts with times while details are fresh, and make late reporting easy.
A workplace concussion often looks minor at the scene and symptoms can show up later.
On site the team’s job is to recognize a possible concussion and refer, not to reach a verdict.
Diagnosis is always a health care provider’s job; return to work is the treating provider’s call.
Document facts with times while details are fresh, and make late reporting easy.
What is a workplace concussion?
Concussion and mild traumatic brain injury (mild TBI) describe the same kind of injury. The American Congress of Rehabilitation Medicine’s 2023 diagnostic criteria note that the two terms may be used interchangeably when brain imaging is normal or not needed (ref-96). A concussion can follow a direct blow to the head or a jolt to the body that moves the head quickly, and a worker does not need to be knocked out to have one (ref-13). What makes it a workplace concussion is simply where and how it happened. That matters because it brings in your site’s first-aid plan, your OSHA recordkeeping, your workers’ compensation process and, later, the work restrictions a provider may set. Diagnosis is always a health care provider’s job. The team on site recognizes and refers.
What is a workplace concussion?
Concussion and mild traumatic brain injury (mild TBI) describe the same kind of injury. The American Congress of Rehabilitation Medicine’s 2023 diagnostic criteria note that the two terms may be used interchangeably when brain imaging is normal or not needed (ref-96). A concussion can follow a direct blow to the head or a jolt to the body that moves the head quickly, and a worker does not need to be knocked out to have one (ref-13). What makes it a workplace concussion is simply where and how it happened. That matters because it brings in your site’s first-aid plan, your OSHA recordkeeping, your workers’ compensation process and, later, the work restrictions a provider may set. Diagnosis is always a health care provider’s job. The team on site recognizes and refers.
Recognize, Refer, Document: the three steps for the first minutes after a head injury at work.
How common is concussion at work, and who is at risk?
Work-related brain injury is not rare. An estimated 586,600 work-related brain injuries were treated in U.S. emergency departments from 1998 to 2007 (ref-7). Across studies, falls were the most common cause of work-related brain injury (ref-6), and vehicle crashes and falls were the leading causes of fatal ones (ref-8). The CDC notes that concussion can happen in any workplace, and that research shows some workers may be at higher risk, such as those in construction, freight trucking and services to buildings and dwellings (ref-79). The cost is real too. Active lost-time workers’ compensation claims involving a traumatic brain injury averaged about $136,000 in total incurred costs from 2013 to 2018, compared with about $51,000 for all lost-time claims (ref-107).
Recognize, Refer, Document: the three steps for the first minutes after a head injury at work.
How common is concussion at work, and who is at risk?
Work-related brain injury is not rare. An estimated 586,600 work-related brain injuries were treated in U.S. emergency departments from 1998 to 2007 (ref-7). Across studies, falls were the most common cause of work-related brain injury (ref-6), and vehicle crashes and falls were the leading causes of fatal ones (ref-8). The CDC notes that concussion can happen in any workplace, and that research shows some workers may be at higher risk, such as those in construction, freight trucking and services to buildings and dwellings (ref-79). The cost is real too. Active lost-time workers’ compensation claims involving a traumatic brain injury averaged about $136,000 in total incurred costs from 2013 to 2018, compared with about $51,000 for all lost-time claims (ref-107).
The CRT6 red flags. Any one of them means call 911.
Why concussion at work is different from concussion in sport
Most concussion tools and habits come from sport. They are a useful starting point, and the CRT6 red flags are a sensible, widely recognized list for non-clinicians (ref-13). Workplaces differ in ways that matter. Nobody is watching closely: there is no athletic trainer on the sideline, and many head strikes happen alone or out of sight. Workers often play it down: people skip reporting injuries out of fear, because the process is a hassle, or because they see the injury as minor or “part of the job” (ref-91). The job itself is the hazard: a worker who returns too early may be driving, working at height or running machinery, and the CDC lists these kinds of tasks as reasons a worker may need more time or changes during recovery (ref-79). Quick sideline checks can mislead: fatigue, recent heavy exertion and age can change balance and eye-movement results in people who do not have a concussion (ref-22, ref-28, ref-35), and a worker at the end of a long, physical shift is exactly that case. The takeaway: on a job site, the goal is to recognize and refer, not to reach a verdict.
The CRT6 red flags. Any one of them means call 911.
Why concussion at work is different from concussion in sport
Most concussion tools and habits come from sport. They are a useful starting point, and the CRT6 red flags are a sensible, widely recognized list for non-clinicians (ref-13). Workplaces differ in ways that matter. Nobody is watching closely: there is no athletic trainer on the sideline, and many head strikes happen alone or out of sight. Workers often play it down: people skip reporting injuries out of fear, because the process is a hassle, or because they see the injury as minor or “part of the job” (ref-91). The job itself is the hazard: a worker who returns too early may be driving, working at height or running machinery, and the CDC lists these kinds of tasks as reasons a worker may need more time or changes during recovery (ref-79). Quick sideline checks can mislead: fatigue, recent heavy exertion and age can change balance and eye-movement results in people who do not have a concussion (ref-22, ref-28, ref-35), and a worker at the end of a long, physical shift is exactly that case. The takeaway: on a job site, the goal is to recognize and refer, not to reach a verdict.
Many quick concussion checks were built for the sideline. Sheldon Victorine, ICI founder, at an athletics sideline.
Step 1: Recognize a possible concussion at work
Start with safety. Stop the task, make the scene safe and stay with the worker. If any red flag is present, call 911. The CRT6 red flags include neck pain or tenderness, seizure, loss of vision or double vision, loss of consciousness, increasing confusion or drowsiness, weakness or tingling in more than one arm or leg, repeated vomiting, severe or increasing headache, increasing restlessness or agitation, and visible deformity of the skull (ref-13). If there are no red flags, look and ask. What you may see: slow to get up, unsteady, a dazed or blank look, confusion, a facial injury (ref-13). What the worker may report: headache or pressure in the head, dizziness, nausea, blurred vision, sensitivity to light or noise, feeling slowed down or foggy, or simply “not feeling right” (ref-13, ref-40). Ask directly and calmly, and make it clear that speaking up is the right call. “No red flags” does not mean “no concussion.” If your first aiders want a consistent way to organize what they are seeing, ICAT is ICI’s free head-injury recognition tool. It supports recognition and referral only. It does not diagnose concussion and does not clear anyone to return to work. For the full first-minutes sequence, see Head Injuries at Work: What to Do in the First Minutes.
Many quick concussion checks were built for the sideline. Sheldon Victorine, ICI founder, at an athletics sideline.
Step 1: Recognize a possible concussion at work
Start with safety. Stop the task, make the scene safe and stay with the worker. If any red flag is present, call 911. The CRT6 red flags include neck pain or tenderness, seizure, loss of vision or double vision, loss of consciousness, increasing confusion or drowsiness, weakness or tingling in more than one arm or leg, repeated vomiting, severe or increasing headache, increasing restlessness or agitation, and visible deformity of the skull (ref-13). If there are no red flags, look and ask. What you may see: slow to get up, unsteady, a dazed or blank look, confusion, a facial injury (ref-13). What the worker may report: headache or pressure in the head, dizziness, nausea, blurred vision, sensitivity to light or noise, feeling slowed down or foggy, or simply “not feeling right” (ref-13, ref-40). Ask directly and calmly, and make it clear that speaking up is the right call. “No red flags” does not mean “no concussion.” If your first aiders want a consistent way to organize what they are seeing, ICAT is ICI’s free head-injury recognition tool. It supports recognition and referral only. It does not diagnose concussion and does not clear anyone to return to work. For the full first-minutes sequence, see Head Injuries at Work: What to Do in the First Minutes.
On site, the job is to recognize and refer, not to diagnose.
On site, the job is to recognize and refer, not to diagnose.
Suspected concussion: off duty for the rest of the shift, and return to work is the provider’s call.
Step 2: Refer to care the same day
If you suspect a concussion, the worker is done for the shift. Keep them away from safety-critical tasks, and do not let them drive themselves. The CRT6 advises that a person with a suspected concussion should not be left alone at first, should not be sent home alone and should not drive until a health care professional says it is safe (ref-13). Decide your referral pathway before you need it. Red flags present: emergency care through 911. No red flags, possible concussion: same-day evaluation by a health care provider, such as your occupational health clinic, urgent care or the worker’s own provider, following your site plan and workers’ compensation process. Send information with the worker: your written notes and a contact name and number at work. Ask for written work instructions. The CDC’s Instructions on Returning to Work form gives a clinician a ready-made way to tell you what changes the worker needs (ref-88).
Step 3: Document what happened
Write facts, not conclusions, while details are fresh:
date, time and exact location;
what struck the head, or what the head struck, and the height of any fall;
PPE worn;
witnesses;
signs observed and symptoms reported, each with a time;
red flags checked and the result;
who was called, where the worker was referred and who they left with.
“Worker reported headache at 10:42 a.m.” helps the provider far more than “mild concussion.”
Whether the case goes on the OSHA log depends on what happens next. Under 29 CFR 1904.7, a work-related injury with loss of consciousness is recordable, and so are days away or restricted work recommended by a clinician (ref-83).
Suspected concussion: off duty for the rest of the shift, and return to work is the provider’s call.
Step 2: Refer to care the same day
If you suspect a concussion, the worker is done for the shift. Keep them away from safety-critical tasks, and do not let them drive themselves. The CRT6 advises that a person with a suspected concussion should not be left alone at first, should not be sent home alone and should not drive until a health care professional says it is safe (ref-13). Decide your referral pathway before you need it. Red flags present: emergency care through 911. No red flags, possible concussion: same-day evaluation by a health care provider, such as your occupational health clinic, urgent care or the worker’s own provider, following your site plan and workers’ compensation process. Send information with the worker: your written notes and a contact name and number at work. Ask for written work instructions. The CDC’s Instructions on Returning to Work form gives a clinician a ready-made way to tell you what changes the worker needs (ref-88).
Step 3: Document what happened
Write facts, not conclusions, while details are fresh:
date, time and exact location;
what struck the head, or what the head struck, and the height of any fall;
PPE worn;
witnesses;
signs observed and symptoms reported, each with a time;
red flags checked and the result;
who was called, where the worker was referred and who they left with.
“Worker reported headache at 10:42 a.m.” helps the provider far more than “mild concussion.”
Whether the case goes on the OSHA log depends on what happens next. Under 29 CFR 1904.7, a work-related injury with loss of consciousness is recordable, and so are days away or restricted work recommended by a clinician (ref-83).
Facts, times and witnesses, captured on the floor where it happened.
When symptoms show up later
Symptoms do not always appear at the moment of impact. The CRT6 notes that symptoms may develop over minutes or hours after a head injury (ref-13). Some workers notice headache, fogginess or poor sleep only after they get home or the next day. Make late reporting easy. OSHA requires a reasonable way for workers to report injuries and prohibits retaliation for reporting (ref-84), and its guidance says reporting procedures must account for injuries that do not seem serious at first or that build over time (ref-85). When a worker reports symptoms later, add them to the original incident record and refer them for evaluation.
Facts, times and witnesses, captured on the floor where it happened.
When symptoms show up later
Symptoms do not always appear at the moment of impact. The CRT6 notes that symptoms may develop over minutes or hours after a head injury (ref-13). Some workers notice headache, fogginess or poor sleep only after they get home or the next day. Make late reporting easy. OSHA requires a reasonable way for workers to report injuries and prohibits retaliation for reporting (ref-84), and its guidance says reporting procedures must account for injuries that do not seem serious at first or that build over time (ref-85). When a worker reports symptoms later, add them to the original incident record and refer them for evaluation.
Plan for late reporting.
Step 4: Support the return to work the provider sets
When a worker returns, and in what capacity, is the treating provider’s call. The employer’s role is to follow the restrictions the provider sets, communicate clearly and make the changes possible. Some context on what providers may recommend: the Living Concussion Guidelines recommend a brief period of rest of about 24 to 48 hours followed by a gradual return to activity, work and school (ref-97); advice to rest for more than 2 days has been linked to a slower return to productivity (ref-61); and preliminary evidence suggests most workers return within 3 to 6 months, with lower education, severe head or body pain early after injury, and jobs with limited independence and decision-making latitude linked to slower returns (ref-73). Accommodations a provider may ask for often look simple. The CDC lists examples such as rest breaks, a shortened schedule or later start, temporary transfer to tasks that do not worsen symptoms, sunglasses or earplugs for light and noise sensitivity, reduced driving and limited use of machinery (ref-79). The Job Accommodation Network adds ideas such as flexible schedules, written instructions and task flow charts (ref-81). In JAN’s employer survey, 61% of employers who shared cost data said the accommodation cost nothing (ref-82). Getting this part wrong has consequences. In one small interview study of 12 workers returning to the place they were hurt, workers said employers and claims staff did not understand their injury, and 6 of 12 were injured again afterward, 3 of them at work (ref-71). What helps, in practice: name one point of contact at work for the worker; ask the provider for written restrictions, and follow them exactly; match tasks to the restrictions, especially for driving, heights and machinery; check in regularly, and pass new or worsening symptoms back to the provider; keep the worker’s medical details private and limited to people who need them.
Plan for late reporting.
Step 4: Support the return to work the provider sets
When a worker returns, and in what capacity, is the treating provider’s call. The employer’s role is to follow the restrictions the provider sets, communicate clearly and make the changes possible. Some context on what providers may recommend: the Living Concussion Guidelines recommend a brief period of rest of about 24 to 48 hours followed by a gradual return to activity, work and school (ref-97); advice to rest for more than 2 days has been linked to a slower return to productivity (ref-61); and preliminary evidence suggests most workers return within 3 to 6 months, with lower education, severe head or body pain early after injury, and jobs with limited independence and decision-making latitude linked to slower returns (ref-73). Accommodations a provider may ask for often look simple. The CDC lists examples such as rest breaks, a shortened schedule or later start, temporary transfer to tasks that do not worsen symptoms, sunglasses or earplugs for light and noise sensitivity, reduced driving and limited use of machinery (ref-79). The Job Accommodation Network adds ideas such as flexible schedules, written instructions and task flow charts (ref-81). In JAN’s employer survey, 61% of employers who shared cost data said the accommodation cost nothing (ref-82). Getting this part wrong has consequences. In one small interview study of 12 workers returning to the place they were hurt, workers said employers and claims staff did not understand their injury, and 6 of 12 were injured again afterward, 3 of them at work (ref-71). What helps, in practice: name one point of contact at work for the worker; ask the provider for written restrictions, and follow them exactly; match tasks to the restrictions, especially for driving, heights and machinery; check in regularly, and pass new or worsening symptoms back to the provider; keep the worker’s medical details private and limited to people who need them.
Training first aiders and supervisors on recognition and referral, where the work happens.
Build it into your safety program
A workplace concussion plan does not need to be long.
Roles: who responds, who refers, who documents, who follows up.
Red flags and referral pathway, posted where first aiders can find them.
Documentation template that matches Step 3.
Late-reporting path that is easy and free of blame.
Return-to-work contact who works from the provider’s written instructions.
Training for first aiders and supervisors on recognition and referral, not diagnosis.
OSHA’s Recommended Practices for Safety and Health Programs is a good frame for where reporting, investigation and follow-up fit (ref-87). If it would help your team, ICI offers workplace concussion training built around Recognize, Refer, Document.
Training first aiders and supervisors on recognition and referral, where the work happens.
Build it into your safety program
A workplace concussion plan does not need to be long.
Roles: who responds, who refers, who documents, who follows up.
Red flags and referral pathway, posted where first aiders can find them.
Documentation template that matches Step 3.
Late-reporting path that is easy and free of blame.
Return-to-work contact who works from the provider’s written instructions.
Training for first aiders and supervisors on recognition and referral, not diagnosis.
OSHA’s Recommended Practices for Safety and Health Programs is a good frame for where reporting, investigation and follow-up fit (ref-87). If it would help your team, ICI offers workplace concussion training built around Recognize, Refer, Document.
Frequently asked questions
A workplace concussion is a mild traumatic brain injury that happens on the job, often from a fall, a struck-by event or a vehicle crash. A health care provider makes the diagnosis. The team on site recognizes a possible concussion and refers the worker to care.
Yes. A worker does not need to be knocked out to have a concussion (ref-13). Loss of consciousness is a red flag that means call 911.
No. If a concussion is suspected, take the worker off duty for the rest of the shift, keep them from driving and safety-critical tasks, and refer them for same-day evaluation.
The treating health care provider. The employer follows the provider’s written restrictions and adjusts tasks to match them.
Yes. Symptoms may develop over minutes or hours (ref-13), and some workers notice them only after the shift. Make late reporting easy, add it to the original incident record and refer for evaluation.
It depends on what happens. A work-related injury with loss of consciousness is recordable, and so are days away or restricted work recommended by a clinician, under 29 CFR 1904.7 (ref-83).
Providers may recommend rest breaks, shorter hours, temporary changes to tasks, reduced driving or limited machinery use (ref-79). JAN lists more ideas, and many accommodations cost nothing (ref-81, ref-82).
No. ICAT is a free recognition and referral tool. It helps trained first aiders organize what they see and decide when to refer. It does not diagnose, clear workers or make return-to-work decisions.
Related: Head Injuries at Work: What to Do in the First Minutes, ICAT, Training & Speaking.
Sources
All sources are listed with summaries on ICI’s research page.
Centers for Disease Control and Prevention. HEADS UP.
Centers for Disease Control and Prevention. TBI in the Workplace Facts.
Job Accommodation Network. Accommodation and Compliance: Brain Injury.
Job Accommodation Network. Costs and Benefits of Accommodation.
Occupational Safety and Health Administration. 29 CFR 1904.7: General recording criteria.
Occupational Safety and Health Administration. 29 CFR 1904.35: Employee involvement.
Related: Head Injuries at Work: What to Do in the First Minutes, ICAT, Training & Speaking.
Sources
All sources are listed with summaries on ICI’s research page.
Centers for Disease Control and Prevention. HEADS UP.
Centers for Disease Control and Prevention. TBI in the Workplace Facts.
Job Accommodation Network. Accommodation and Compliance: Brain Injury.
Job Accommodation Network. Costs and Benefits of Accommodation.
Occupational Safety and Health Administration. 29 CFR 1904.7: General recording criteria.
Occupational Safety and Health Administration. 29 CFR 1904.35: Employee involvement.
Sheldon Victorine, MS, ATC, CSCS
Sheldon Victorine is the Founder & Lead Researcher of the Industrial Concussion Institute in Eugene, Oregon. His work centers on health, safety and ergonomics, supported by a background in athletic training and 7 years of service in the U.S. Navy. He is an NSCA Certified Strength and Conditioning Specialist (CSCS) and builds evidence-informed tools and training that help workplaces recognize head injuries, refer workers to care and document what happened.
About Sheldon · LinkedIn
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Sheldon Victorine, MS, ATC, CSCS
Sheldon Victorine is the Founder & Lead Researcher of the Industrial Concussion Institute in Eugene, Oregon. His work centers on health, safety and ergonomics, supported by a background in athletic training and 7 years of service in the U.S. Navy. He is an NSCA Certified Strength and Conditioning Specialist (CSCS) and builds evidence-informed tools and training that help workplaces recognize head injuries, refer workers to care and document what happened.
About Sheldon · LinkedIn
Keep reading
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