Head Protection Survey

How long have you been skating, and what is your current level? *

Have you ever fallen and hit your head on the ice or received an impact (either directly or indirectly) to your head or neck while ice skating? *YesNoHead injury can arise from direct injury at the impact site or indirect injury caused by movement of the brain within the skull. An indirect injury can occur without a head impact.

Please provide brief details of the fall or impact:

Were you wearing head protection? *YesNo

What type of head protection were you wearing? *Ice Hockey HelmetBicycle HelmetSki / Snowboard HelmetSkate Helmet (roller, inline skateboard)Protective headband / HaloOther headwear that contains padding designed to absorb impactOther

Which protective headband/halo were you wearing? *

Do you feel that the headband / halo provided adequate protection? *YesNo

Please provide details of why the headband / halo did not provide adequate protection: *

Please provide details (type, brand and model) *

Do you feel that this form of headwear provided adequate protection? *YesNo

Please provide details of why this headwear did not provide adequate protection: *

Were you diagnosed with a concussion? *YesNo

What level was your concussion?MildModerateSevere

How old were you when you sustained the concussion? *

Have you experienced more than 1 concussion *YesNo

How many concussions have you had? *

Did you wear head protection when you returned to skating after your concussion?YesNo

Have you ever completed a graduated return to skating programme following a head injury or concussion? *YesNo

Did you wear head protection during your graduated return to skating programme? *YesNo

Do you wear head protection when you're on the ice? *Yes, every time I skateSometimesOnly when it is mandatoryNo

Which head protection do you wear? *Ice Hockey HelmetBicycle HelmetSnowboard/Ski HelmetSkateboarding/Roller/Inline Skating HelmetProtective Headband / HaloOther headwear that contains impact absorbing materialsOther

Would you consider wearing head protection on the ice even if it is not compulsory? *YesNo

Which head protection would you be most likely to wear? *Ice Hockey HelmetBicycle HelmetSnowboard/Ski HelmetSkateboarding/Roller/Inline Skating HelmetProtective Headband / HaloOther form of headwear that contains impact absorbing materials

Do you have any comments regarding head protection or concussions in ice skating?

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Head Protection and Concussion in Ice Skating Survey

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