Head Injuries at Work: What to Do in the First Minutes
Head Injuries at Work: What to Do in the First Minutes
Recognize, Refer, Document for first aiders and supervisors
Recognize, Refer, Document for first aiders and supervisors
Sheldon Victorine, MS, ATC, CSCS
Published October 12, 2026
When a worker has a head injury in the workplace, stop the work, check for red flags and call 911 if you see any. If there are no red flags, take the worker off duty for the rest of the shift, refer them to a health care provider the same day, and write down what happened while it is still fresh. That is Recognize, Refer, Document, and it is built to support first aiders and supervisors, not to replace medical care.
Educational content for workplace safety teams. It is not medical advice and does not replace evaluation by a licensed health care professional.
When a worker has a head injury in the workplace, stop the work, check for red flags and call 911 if you see any. If there are no red flags, take the worker off duty for the rest of the shift, refer them to a health care provider the same day, and write down what happened while it is still fresh. That is Recognize, Refer, Document, and it is built to support first aiders and supervisors, not to replace medical care.
Educational content for workplace safety teams. It is not medical advice and does not replace evaluation by a licensed health care professional.
What should you do right after a worker hits their head?
The first minutes after a head strike are rarely calm. Someone is on the ground or holding their head, a crew is gathering, and everyone is waiting to see what the person in charge does next. Having a short, practiced sequence takes a lot of the guesswork out of that moment:
Stop the task and make the scene safe. Shut down or lock out equipment, control traffic and get people clear of whatever caused the injury.
Stay with the worker. Keep them still and talk to them calmly.
Check for red flags (next section). If any are present, call 911.
If there are no red flags, remove them from duty, refer them for evaluation and document what happened.
If a neck injury is possible, do not move the worker unless the scene itself is unsafe. OSHA expects workplaces to have trained first-aid help and access to medical care in place before anyone needs it (ref-86), so this sequence should already be part of your first aiders’ training.
Taking this seriously is about more than caution. An estimated 586,600 work-related brain injuries were treated in U.S. emergency departments from 1998 to 2007, and they were far more likely than other work injuries to need a hospital stay (ref-7).
What should you do right after a worker hits their head?
The first minutes after a head strike are rarely calm. Someone is on the ground or holding their head, a crew is gathering, and everyone is waiting to see what the person in charge does next. Having a short, practiced sequence takes a lot of the guesswork out of that moment:
Stop the task and make the scene safe. Shut down or lock out equipment, control traffic and get people clear of whatever caused the injury.
Stay with the worker. Keep them still and talk to them calmly.
Check for red flags (next section). If any are present, call 911.
If there are no red flags, remove them from duty, refer them for evaluation and document what happened.
If a neck injury is possible, do not move the worker unless the scene itself is unsafe. OSHA expects workplaces to have trained first-aid help and access to medical care in place before anyone needs it (ref-86), so this sequence should already be part of your first aiders’ training.
Taking this seriously is about more than caution. An estimated 586,600 work-related brain injuries were treated in U.S. emergency departments from 1998 to 2007, and they were far more likely than other work injuries to need a hospital stay (ref-7).
Recognize, Refer, Document: the first minutes after a head injury.
What are the red flags that mean call 911?
The most widely used list for non-clinicians comes from the Concussion Recognition Tool 6 (CRT6), published with the 2022 Amsterdam consensus on concussion in sport (ref-13, ref-14, ref-95). The CRT6 lists these “Red Flags: CALL AN AMBULANCE”:
“Neck pain or tenderness”
“Seizure, ‘fits’, or convulsion”
“Loss of vision or double vision”
“Loss of consciousness”
“Increased confusion or deteriorating conscious state (becoming less responsive, drowsy)”
“Weakness or numbness/tingling in more than one arm or leg”
“Repeated Vomiting”
“Severe or increasing headache”
“Increasingly restless, agitated or combative”
“Visible deformity of the skull”
If you see any of these, call 911 or your site’s emergency number. The CRT6 also reminds responders to follow basic first aid (check for danger, airway, breathing and circulation), not to move the injured person other than for airway support unless trained to do so, not to remove a helmet, and to “assume a possible spinal cord injury in all cases of head injury” (ref-13).
A note in fairness to the tool: the CRT6 was written for sport, so it talks about athletes and the playing surface. Its red flags are still a sensible, widely recognized starting point on a job site. Just remember that “no red flags” does not mean “no concussion.”
Recognize, Refer, Document: the first minutes after a head injury.
What are the red flags that mean call 911?
The most widely used list for non-clinicians comes from the Concussion Recognition Tool 6 (CRT6), published with the 2022 Amsterdam consensus on concussion in sport (ref-13, ref-14, ref-95). The CRT6 lists these “Red Flags: CALL AN AMBULANCE”:
“Neck pain or tenderness”
“Seizure, ‘fits’, or convulsion”
“Loss of vision or double vision”
“Loss of consciousness”
“Increased confusion or deteriorating conscious state (becoming less responsive, drowsy)”
“Weakness or numbness/tingling in more than one arm or leg”
“Repeated Vomiting”
“Severe or increasing headache”
“Increasingly restless, agitated or combative”
“Visible deformity of the skull”
If you see any of these, call 911 or your site’s emergency number. The CRT6 also reminds responders to follow basic first aid (check for danger, airway, breathing and circulation), not to move the injured person other than for airway support unless trained to do so, not to remove a helmet, and to “assume a possible spinal cord injury in all cases of head injury” (ref-13).
A note in fairness to the tool: the CRT6 was written for sport, so it talks about athletes and the playing surface. Its red flags are still a sensible, widely recognized starting point on a job site. Just remember that “no red flags” does not mean “no concussion.”
The CRT6 red flags. If you see any one of them, call 911.
How do you recognize a possible concussion at work?
Most concussions do not look dramatic. The CRT6 describes visible clues such as lying motionless, being slow to get up after a hit to the head, being unsteady on their feet, a dazed or vacant look, disorientation or confusion, and facial injury (ref-13). Workers may also tell you about headache, “pressure in head,” dizziness, nausea, blurred vision, sensitivity to light or noise, feeling slowed down or “in a fog,” or simply that they “don’t feel right” (ref-13, ref-40).
Here is the part that matters most on a job site: workers often play it down. Across studies, 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). In high-risk work, stigma and a tough-it-out culture can make that even stronger (ref-89). So ask directly, ask calmly, and make it clear that speaking up is the right call.
It also helps to know that quick balance and eye-movement checks, the kind often borrowed from the sideline, can mislead. Fatigue, recent heavy exertion, age and a history of motion sickness can all change results in people who do not have a concussion at all (ref-22, ref-28, ref-34, ref-35). A worker coming off a long, physical shift is exactly that case. That is why the goal on site is to recognize and refer, not to reach a verdict.
This is where ICAT, ICI’s free head-injury recognition tool, fits. ICAT helps a trained first aider organize what they are seeing and decide whether to refer. It does not diagnose concussion, and it does not clear anyone to return to work.
The CRT6 red flags. If you see any one of them, call 911.
How do you recognize a possible concussion at work?
Most concussions do not look dramatic. The CRT6 describes visible clues such as lying motionless, being slow to get up after a hit to the head, being unsteady on their feet, a dazed or vacant look, disorientation or confusion, and facial injury (ref-13). Workers may also tell you about headache, “pressure in head,” dizziness, nausea, blurred vision, sensitivity to light or noise, feeling slowed down or “in a fog,” or simply that they “don’t feel right” (ref-13, ref-40).
Here is the part that matters most on a job site: workers often play it down. Across studies, 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). In high-risk work, stigma and a tough-it-out culture can make that even stronger (ref-89). So ask directly, ask calmly, and make it clear that speaking up is the right call.
It also helps to know that quick balance and eye-movement checks, the kind often borrowed from the sideline, can mislead. Fatigue, recent heavy exertion, age and a history of motion sickness can all change results in people who do not have a concussion at all (ref-22, ref-28, ref-34, ref-35). A worker coming off a long, physical shift is exactly that case. That is why the goal on site is to recognize and refer, not to reach a verdict.
This is where ICAT, ICI’s free head-injury recognition tool, fits. ICAT helps a trained first aider organize what they are seeing and decide whether to refer. It does not diagnose concussion, and it does not clear anyone to return to work.
A calm, direct check-in makes it easier for workers to speak up.
Should the worker go back to work the same day?
If you suspect a concussion, the answer is no. Take the worker off duty for the rest of the shift, and keep them away from safety-critical tasks such as driving, working at height or running machinery until a health care provider has evaluated them. The CRT6 is clear that a person with a suspected concussion should not be left alone at first (at least for the first 3 hours), should not be sent home by themselves, and should not drive until a health care professional says it is safe (ref-13). Arrange a ride, and make sure someone stays with them.
When they can return, and in what capacity, is the treating provider’s call. The employer’s job is to follow the restrictions the provider sets. For context on what that provider may recommend, current guidelines favor a short period of rest of about 24 to 48 hours followed by a gradual return to activity and work (ref-97), and advice to rest for more than 2 days has been linked to a slower return to productivity (ref-61).
A calm, direct check-in makes it easier for workers to speak up.
Should the worker go back to work the same day?
If you suspect a concussion, the answer is no. Take the worker off duty for the rest of the shift, and keep them away from safety-critical tasks such as driving, working at height or running machinery until a health care provider has evaluated them. The CRT6 is clear that a person with a suspected concussion should not be left alone at first (at least for the first 3 hours), should not be sent home by themselves, and should not drive until a health care professional says it is safe (ref-13). Arrange a ride, and make sure someone stays with them.
When they can return, and in what capacity, is the treating provider’s call. The employer’s job is to follow the restrictions the provider sets. For context on what that provider may recommend, current guidelines favor a short period of rest of about 24 to 48 hours followed by a gradual return to activity and work (ref-97), and advice to rest for more than 2 days has been linked to a slower return to productivity (ref-61).
Return-to-work decisions belong to a qualified healthcare provider.
Return-to-work decisions belong to a qualified healthcare provider.
If you suspect a concussion, the worker stays off duty for the rest of the shift.
Where should you refer a worker with a possible concussion?
Referral is simple to describe and easy to skip, so decide your pathway before you need it:
Red flags present: emergency care, through 911.
No red flags, but you suspect a 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 the worker with your written notes (next section) and the name and number of a contact at work. Ask the provider for written work instructions. The CDC’s Instructions on Returning to Work form is a ready-made way for a clinician to tell you what changes the worker needs (ref-88).
If your site does not yet have this written down, a written workplace concussion protocol should cover roles, referral pathways and documentation.
If you suspect a concussion, the worker stays off duty for the rest of the shift.
Where should you refer a worker with a possible concussion?
Referral is simple to describe and easy to skip, so decide your pathway before you need it:
Red flags present: emergency care, through 911.
No red flags, but you suspect a 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 the worker with your written notes (next section) and the name and number of a contact at work. Ask the provider for written work instructions. The CDC’s Instructions on Returning to Work form is a ready-made way for a clinician to tell you what changes the worker needs (ref-88).
If your site does not yet have this written down, a written workplace concussion protocol should cover roles, referral pathways and documentation.
Decide your referral pathway before you need it.
What should you write down after a head injury at work?
Good notes protect the worker, help the provider and make your follow-up much easier. Capture:
Date, time and exact location
What happened: what struck the head or what the head struck, and the height of any fall
PPE worn, including the type of hard hat
Witnesses
Signs you observed and symptoms the worker reported, each with a time
Which red flags you checked, and the result
Who you called and when
Where the worker was referred, how they got there and who they were released to
Write facts, not conclusions: “Worker reported headache at 10:42 a.m.” is far more useful than “mild concussion.” These notes also feed incident investigation and hazard correction inside your safety program (ref-87).
Whether the case goes on the OSHA log depends on what happens next, such as loss of consciousness, days away from work, restricted work or medical treatment beyond first aid, under the general recording criteria (ref-83) in 29 CFR 1904.7.
What should you write down after a head injury at work?
Good notes protect the worker, help the provider and make your follow-up much easier. Capture:
Date, time and exact location
What happened: what struck the head or what the head struck, and the height of any fall
PPE worn, including the type of hard hat
Witnesses
Signs you observed and symptoms the worker reported, each with a time
Which red flags you checked, and the result
Who you called and when
Where the worker was referred, how they got there and who they were released to
Write facts, not conclusions: “Worker reported headache at 10:42 a.m.” is far more useful than “mild concussion.” These notes also feed incident investigation and hazard correction inside your safety program (ref-87).
Whether the case goes on the OSHA log depends on what happens next, such as loss of consciousness, days away from work, restricted work or medical treatment beyond first aid, under the general recording criteria (ref-83) in 29 CFR 1904.7.
Write down what happened while it is still fresh.
What if symptoms show up hours or days later?
Symptoms are not always obvious at the moment of impact. The CRT6 notes that “symptoms may develop over minutes or hours following a head injury” (ref-13), and some workers notice headache, fogginess or poor sleep only after they get home.
Make late reporting easy. OSHA requires a reasonable way for workers to report injuries and prohibits retaliation for reporting (ref-84), and it says reporting procedures must account for injuries that do not seem serious at first or that build over time (ref-85). Before the worker leaves, tell them and whoever is with them which red flags mean emergency care. If symptoms come up later, add them to the original incident record instead of starting a new, disconnected one. There is more on this in delayed concussion symptoms after a work injury.
Write down what happened while it is still fresh.
What if symptoms show up hours or days later?
Symptoms are not always obvious at the moment of impact. The CRT6 notes that “symptoms may develop over minutes or hours following a head injury” (ref-13), and some workers notice headache, fogginess or poor sleep only after they get home.
Make late reporting easy. OSHA requires a reasonable way for workers to report injuries and prohibits retaliation for reporting (ref-84), and it says reporting procedures must account for injuries that do not seem serious at first or that build over time (ref-85). Before the worker leaves, tell them and whoever is with them which red flags mean emergency care. If symptoms come up later, add them to the original incident record instead of starting a new, disconnected one. There is more on this in delayed concussion symptoms after a work injury.
Symptoms can appear after the shift, so make late reporting easy.
How can your team prepare before the next head injury?
The best time to practice Recognize, Refer, Document is before anyone needs it:
Train first aiders and supervisors on recognition and referral, not diagnosis. Our workplace concussion training is built for exactly that.
Write a short protocol covering roles, red flags, referral pathways, documentation and follow-up.
Know your highest-risk tasks. Falls were the most common cause of work-related brain injury across studies (ref-6), and vehicle crashes and falls were the leading causes of fatal ones (ref-8).
Make the business case. 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).
Put ICAT where your first aiders already are, on the phones and tablets they carry.
None of this asks your team to become clinicians. It asks them to notice, act and write it down, every time.
Symptoms can appear after the shift, so make late reporting easy.
How can your team prepare before the next head injury?
The best time to practice Recognize, Refer, Document is before anyone needs it:
Train first aiders and supervisors on recognition and referral, not diagnosis. Our workplace concussion training is built for exactly that.
Write a short protocol covering roles, red flags, referral pathways, documentation and follow-up.
Know your highest-risk tasks. Falls were the most common cause of work-related brain injury across studies (ref-6), and vehicle crashes and falls were the leading causes of fatal ones (ref-8).
Make the business case. 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).
Put ICAT where your first aiders already are, on the phones and tablets they carry.
None of this asks your team to become clinicians. It asks them to notice, act and write it down, every time.
Know your highest-risk tasks before anyone gets hurt.
Know your highest-risk tasks before anyone gets hurt.
Sources
All sources are listed with summaries on ICI’s research page.
Centers for Disease Control and Prevention. HEADS UP.
Occupational Safety and Health Administration. 29 CFR 1904.7: General recording criteria.
Occupational Safety and Health Administration. 29 CFR 1904.35: Employee involvement.
Occupational Safety and Health Administration. 29 CFR 1910.151: Medical services and first aid.
Sources
All sources are listed with summaries on ICI’s research page.
Centers for Disease Control and Prevention. HEADS UP.
Occupational Safety and Health Administration. 29 CFR 1904.7: General recording criteria.
Occupational Safety and Health Administration. 29 CFR 1904.35: Employee involvement.
Occupational Safety and Health Administration. 29 CFR 1910.151: Medical services and first aid.
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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