Application for use of HIA and use of
temporary substitutions/replacements
HIA
Mandatory Player Welfare Standards Yes No
1
All on-field team medical staff and Tournament match day medical staff have completed the
following World Rugby online education modules:
2
• Concussion Management for Elite Level Match Day Medical Staff
• Medical Protocols for Match Day Medical Staff
They must also have completed the following face-to face course:
• Level 2 Immediate Care in Rugby or equivalent
Confirmation of completion of education modules is available by contacting
mark.harrington@worldrugby.org
All players and team management have completed a concussion education session (delivered by
the Union CMO or relevant team doctor) within the year prior to commencement of the
Tournament. This education session as a minimum must cover the essential information outlined in
HIA Protocol document and Appendices
3
Each player has completed a baseline concussion assessment in the year prior to commencement
of the tournament and the results of this baseline are available to the team medical staff. As a
minimum this baseline should be a SCAT 5 however it is recommended that teams also include a
computer neurocognitive assessment as part of a player’s annual baseline assessment.
4
A concussion risk stratification (see HIA Protocol document and Appendices) has been completed
on all players, at least annually, to support concussion management on an individual basis.
5
All team medical staff, coaches and team management will comply with the World Rugby
permanent and temporary removal from field of play criteria for head impact events (available in
HIA Protocol document and Appendices and in the HIA Form 1).
6
All team medical staff, coaches and team management will comply with a Graduated Return to Play
programme as approved by World Rugby and/or the union in accordance with medical practice in
the relevant jurisdiction.
7
All teams within the respective tournament will participate in World Rugby HIA research and will
confirm player consent has been obtained (HIA Protocol document and Appendices)
8
All team staff acknowledge that an HIA REVIEW PROCESS has been established to support team
medical staff to optimize player welfare and safety for game head injuries. Specifically for incidents
where criteria, identified in the HIA, for permanent and temporary removal from play following a
head injury are not enforced review and education will be applied. Also all team staff acknowledge
that they will participate if requested in any HIA REVIEW PROCESS or if appropriate any disciplinary
proceeding that may arise following this HIA REVIEW PROCESS .
9
All team staff acknowledge that the Match Day Doctor has the power under Regulation 15.2.1(c) to
unilaterally remove an injured player from further game participation.
10
All teams agree to use the World Rugby current HIA Process, HIA Form 1, HIA Form 2 and HIA Form 3
during this temporary replacement for head injury unless exemption is provided by World Rugby.
2. CORE (MANDATORY) CONCUSSION PLAYER WELFARE STANDARDS
The following player welfare standards relate to concussion and must be included within the Tournament Terms of Participation
or Tours Agreement and signed by participating unions and/or teams in order to access temporary replacement for a Head
Injury Assessment. Please indicate whether these provisions are in place.