The concussion identification, management and return-to-play policy statement of the New Jersey State Interscholastic Athletic Association (NJSIAA) is among the strictest in the country, requiring a 12-day minimum return-to-play waiting period for any athlete suspected of having suffered a concussion.

The NJSIAA, which is the governing body for high school athletics in New Jersey, recommends that its member schools require:

• Mandatory concussion education forms. Before the start of each school year, student-athletes (including cheerleaders) and their parents, will be given a concussion information sheet and required to sign a copy of the form along with all pre-participation physical examination forms [1], acknowledging receipt.
• Annual training: Athletes, coaches and athletic trainers must undergo annual training about concussions, including awareness of symptoms [2], and show proof of satisfactory completion of that training. [The NJSIAA acknowledged the key role ATCs play [3] in any concussion education and management program]
• Removal from play/medical evaluation
  • Immediate removal from play of athletes (a) suspected of having suffered a concussion; (b) who have sustained a concussion and/or (c) lost conciousness during an athletic event;
  • Medical evaluation (including use of symptom checklists [4], baseline [5] and balance [6] testing) to determine the presence/absence of concussion; and
• Return to play guidelines. For those athletes diagnosed with a concussion, no return to play until:
  • The athlete completes a symptom-free week, followed by
  • Completion of a six-step graduated return-to-play exercise protocol [7]  over a minimum of five days, during which time the athlete must be monitored for any recurrence of concussion symptoms [2], for a total minimum time before return to play of twelve days. 
    • If the student-athlete experiences a re-emergence of any post-concussion signs or symptoms once they return to play, they must stop playing and return to their primary care physician or team doctor for re-evaluation;
    • If concussion symptoms reoccur during the graduated return-to-play exercise protocol [7], the athlete must return to the previous level of activity that caused no symptoms and then advance to the next step as tolerated.