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International Accreditation of Healthcare Facilities

Standards › ASF Health Standards v10 › Standard 20

Standard 20

Sports Medicine

Sports medicine: assessment before clearance, staged return to sport, pre-participation checks, qualified clinicians, event emergency plans, banned substances, training load and head injury.

8
criteria
13
documents
6
e-learning courses
6
references

Criteria on this page

20.120.220.320.420.520.620.720.8

How to read the colours
Red: Must. Required in every setting. Criteria that protect life are always red.
Green: Medium. Required, adapted to what a transition setting can realistically do.
Yellow: Minimum. The lowest acceptable level in a humanitarian setting, where resources are very limited.

Each criterion is shown in three settings: Humanitarian settings, Transition and fragile, and Standard. In standard settings, every criterion is Must.

Reference, not a requirement. Every policy, SOP, form and course on this page is a draft to help you. Adapt it to your hospital, write your own, or upload your own documents. What the assessor checks is that the standard is met and that you can show how.
Training colours: red means essential, green recommended, yellow optional. Each course shows its level for each setting: humanitarian, transition and fragile, and standard.
20.1Each Athlete Has a Clinical AssessmentHumanitarian settings: MustTransition and fragile: MustStandard: Must

Each athlete is assessed before treatment or clearance. The assessment records the injury or condition, the sport and training load, and any red flags needing urgent medical review. Red flags are referred for urgent review.

Humanitarian settings
Must
Transition and fragile
Must
Standard
Must

Why it matters. An athlete treated without a proper assessment may be hurt further, or cleared to play while still injured. The assessment is the basis for every later decision on treatment and return to sport.

How the surveyor verifies this criterion

Sample. Review 5 completed athlete assessments in the last 6 months, and the assessment template in use.

1. Each athlete is assessed before treatment or clearance.

Method. Check each sampled athlete for an assessment dated before clearance.

Evidence to show. Athlete assessment record (SPM-FRM-001).

Pass when. Every sampled athlete has an assessment before clearance.

2. Each assessment records the injury or condition, the sport and the training load.

Method. Check each assessment for the three items.

Evidence to show. Athlete assessment record (SPM-FRM-001).

Pass when. Every assessment has all three items recorded.

3. Each red flag is referred for urgent review.

Method. Check each red flag for the referral and its date.

Evidence to show. Athlete assessment record (SPM-FRM-001).

Pass when. Every red flag has an urgent referral recorded.

Immediate fail (any one means the criterion is not met). An athlete is cleared to train with no assessment on file.

Staff responsible

Role Responsibility Level
Sports medicine physician (ISCO 2212) Assesses each athlete and refers red flags Must
Manager (ISCO 1342) Audits assessment records Must

Documents: who does each step

Document Writes Approves Fills in Checks and signs Files and uploads
SPM-FRM-001 · Athlete assessment record Manager (ISCO 1342) Chief executive (ISCO 1120) Secretary (ISCO 3344) Manager (ISCO 1342) Secretary (ISCO 3344)
SPM-POL-001 · Athlete assessment before treatment or clearance Chief executive (ISCO 1120) Governing body members N/A Chief executive (ISCO 1120) Secretary (ISCO 3344)

E-learning: who must take each course

Course Who must take it
Pre-Participation Screening & Risk Assessment (FIT-01) Physician; Physiotherapist; Manager

References

In process of development. Will be available soon.

20.2Return-to-Sport Decisions Are Staged and DocumentedHumanitarian settings: MinimumTransition and fragile: MustStandard: Must

Return to sport follows a staged plan, with defined criteria met at each stage. The decision and its basis are recorded.

Humanitarian settings
Minimum
Transition and fragile
Must
Standard
Must

Why it matters. Returning to sport too early is a common cause of re-injury. A staged plan with clear criteria at each stage, and a record of the decision, protects the athlete and the clinician who signs it off.

How the surveyor verifies this criterion

Sample. Review 3 completed return-to-sport plans with the decision records.

1. Return to sport follows a staged plan.

Method. Check each plan for the stages set.

Evidence to show. Return-to-sport decision record (SPM-FRM-002).

Pass when. Every plan has defined stages.

2. Criteria are met at each stage before the next.

Method. Check each stage for the criteria met and the date.

Evidence to show. Return-to-sport decision record (SPM-FRM-002).

Pass when. Every stage has its criteria met before advancing.

3. The decision and its basis are recorded.

Method. Check each decision for the recorded basis.

Evidence to show. Return-to-sport decision record (SPM-FRM-002).

Pass when. Every decision has its basis recorded.

Immediate fail (any one means the criterion is not met). An athlete is back in full competition after a single test.

Staff responsible

Role Responsibility Level
Sports medicine physician (ISCO 2212) Signs off each return decision Must
Physiotherapist (ISCO 2264) Runs the staged plan with the athlete Must

Documents: who does each step

Document Writes Approves Fills in Checks and signs Files and uploads
SPM-FRM-002 · Return-to-sport decision record Manager (ISCO 1342) Chief executive (ISCO 1120) Secretary (ISCO 3344) Manager (ISCO 1342) Secretary (ISCO 3344)
SPM-POL-002 · Return to sport Chief executive (ISCO 1120) Governing body members N/A Chief executive (ISCO 1120) Secretary (ISCO 3344)

E-learning: who must take each course

In process of development. Will be available soon.

References

  1. World Health Organization (2025). Using the Package of Interventions for Rehabilitation in Georgia. Used for: functional review and recovery after injury, before a return decision. https://news.gmj.ge/guideline/using-the-package-of-interventions-for-rehabilitation-in-georgia/
20.3Pre-Participation Checks Are Done Where RequiredHumanitarian settings: MinimumTransition and fragile: MustStandard: Must

Where the sport or the athlete’s age requires it, a pre-participation check is carried out, including cardiac screening where indicated, and the result is recorded. Abnormal findings are referred for specialist review.

Humanitarian settings
Minimum
Transition and fragile
Must
Standard
Must

Why it matters. Some athletes have heart or other conditions that a sport can make dangerous. Where the sport or the athlete’s age requires it, a check before participation finds those risks before they cause harm.

How the surveyor verifies this criterion

Sample. Review the pre-participation check requirements and the check records for 5 athletes.

1. The required check is carried out for each sport and age that requires it.

Method. Check each athlete against the requirement for their sport and age.

Evidence to show. Pre-participation check requirements and register (SPM-REG-001).

Pass when. Every athlete who requires a check has one recorded.

2. Cardiac screening is carried out where indicated.

Method. Check each athlete where indicated for the screening record.

Evidence to show. Pre-participation check record (SPM-FRM-003).

Pass when. Every indicated athlete has cardiac screening recorded.

3. Abnormal findings are referred for specialist review.

Method. Check each abnormal finding for the referral.

Evidence to show. Pre-participation check record (SPM-FRM-003).

Pass when. Every abnormal finding has a specialist referral.

Immediate fail (any one means the criterion is not met). A young athlete is in competition with no check on file.

Staff responsible

Role Responsibility Level
Sports medicine physician (ISCO 2212) Decides on screening and specialist referral Must
Secretary (ISCO 3344) Keeps the check register Must

Documents: who does each step

Document Writes Approves Fills in Checks and signs Files and uploads
SPM-FRM-003 · Pre-participation check record Manager (ISCO 1342) Chief executive (ISCO 1120) Secretary (ISCO 3344) Manager (ISCO 1342) Secretary (ISCO 3344)
SPM-REG-001 · Pre-participation check requirements and register Secretary (ISCO 3344) Chief executive (ISCO 1120) Secretary (ISCO 3344) Manager (ISCO 1342) Secretary (ISCO 3344)

E-learning: who must take each course

Course Who must take it
Pre-Participation Screening & Risk Assessment (FW-01) Physician; Physiotherapist

References

20.4Staff Are Qualified for the Care They GiveHumanitarian settings: MinimumTransition and fragile: MustStandard: Must

Each clinician’s qualification is verified and current, and is checked against the scope of practice the role requires.

Humanitarian settings
Minimum
Transition and fragile
Must
Standard
Must

Why it matters. Sports clinicians work with athletes at high demand, and a clinician working outside their qualification or scope can cause serious harm. Checking qualifications against the role keeps the care within what the clinician is competent to give.

How the surveyor verifies this criterion

Sample. Review the clinician qualification register and the verification records for 5 clinicians.

1. Each clinician’s qualification is verified and current.

Method. Check each entry for the verification date and expiry.

Evidence to show. Clinician qualification and scope register (SPM-REG-002).

Pass when. Every clinician has a verified, current qualification.

2. Each clinician’s qualification is matched to the scope of the role.

Method. Check each clinician against the scope required.

Evidence to show. Clinician qualification and scope register (SPM-REG-002).

Pass when. Every clinician’s scope matches the role.

3. Expired or unchecked qualifications are not used.

Method. Check the rota against the register for any expired entry.

Evidence to show. Clinician qualification and scope register (SPM-REG-002).

Pass when. No clinician treats athletes with an expired or unchecked qualification.

Immediate fail (any one means the criterion is not met). A clinician treats athletes with an expired licence.

Staff responsible

Role Responsibility Level
Manager (ISCO 1342) Verifies qualifications and scope Must
Secretary (ISCO 3344) Keeps the qualification register Must

Documents: who does each step

Document Writes Approves Fills in Checks and signs Files and uploads
SPM-REG-002 · Clinician qualification and scope register Secretary (ISCO 3344) Chief executive (ISCO 1120) Secretary (ISCO 3344) Manager (ISCO 1342) Secretary (ISCO 3344)

E-learning: who must take each course

Course Who must take it
Credentialing, Competence and the Training Matrix (T-14) Manager; Physician; Physiotherapist

References

In process of development. Will be available soon.

20.5Emergency Response for Sports Events Is PlannedHumanitarian settings: MustTransition and fragile: MustStandard: Must

Where the provider covers sports events, an emergency plan is in place for each event, covering cardiac arrest, heat illness and head injury, with equipment and trained staff present.

Humanitarian settings
Must
Transition and fragile
Must
Standard
Must

Why it matters. Sports events are where cardiac arrests and serious injuries happen, often far from a hospital. A plan made before the event, with equipment and people ready, is what saves the athlete in the first minutes.

How the surveyor verifies this criterion

Sample. Review the emergency plan and the equipment and staff check for a sample event, and the training record.

1. An emergency plan is in place for each sports event.

Method. Check each sampled event for a plan written for that event.

Evidence to show. Emergency plan for each sports event (SPM-PLN-001).

Pass when. Every sampled event has a plan for its venue.

2. The plan covers cardiac arrest, heat illness and head injury.

Method. Check each plan for the three topics.

Evidence to show. Emergency plan for each sports event (SPM-PLN-001).

Pass when. Every plan covers the three topics.

3. Equipment and trained staff are present at each event.

Method. Check the event equipment and staff check record.

Evidence to show. Event equipment and staff check record (SPM-FRM-004).

Pass when. Every event has the AED, equipment and trained staff recorded on site.

Immediate fail (any one means the criterion is not met). An event goes ahead with no emergency plan and no trained person present.

Staff responsible

Role Responsibility Level
Sports medicine physician (ISCO 2212) Leads the medical response at events Must
Manager (ISCO 1342) Signs off each event plan Must

Documents: who does each step

Document Writes Approves Fills in Checks and signs Files and uploads
SPM-FRM-004 · Event equipment and staff check record Manager (ISCO 1342) Chief executive (ISCO 1120) Secretary (ISCO 3344) Manager (ISCO 1342) Secretary (ISCO 3344)
SPM-PLN-001 · Emergency plan for each sports event Chief executive (ISCO 1120) Governing body members Manager (ISCO 1342) Chief executive (ISCO 1120) Secretary (ISCO 3344)

E-learning: who must take each course

Course Who must take it
Emergency Medical Equipment & AED Readiness (MED-02) Physician; Physiotherapist; Manager

References

  1. World Health Organization (2026). Prevention and management of heat-related illness at mass gatherings: risk assessment tool. Used for: heat illness risk at sports events and other mass gatherings. https://news.gmj.ge/guideline/prevention-and-management-of-heat-related-illness-at-mass-gatherings-risk-assessment-tool/
  2. World Health Organization (2026). Prevention and management of heat-related illness at mass gatherings: systematic reviews. Used for: prevention and management of heat illness at sports events. https://news.gmj.ge/guideline/prevention-and-management-of-heat-related-illness-at-mass-gatherings-systematic-reviews/
  3. World Health Organization (2025). Mass gathering practical guide for simulation exercises and after action reviews. Used for: planning and rehearsing the medical response at sports events. https://news.gmj.ge/guideline/mass-gathering-practical-guide-for-simulation-exercises-and-after-action-reviews/
20.6Anti-Doping and Medicines Are Handled CorrectlyHumanitarian settings: MinimumTransition and fragile: MediumStandard: Must

Where relevant, the provider advises athletes on banned substances, and records prescribing that may affect an athlete’s eligibility.

Humanitarian settings
Minimum
Transition and fragile
Medium
Standard
Must

Why it matters. Some medicines, and some supplements, contain substances banned in sport. An athlete who takes them unknowingly can lose a title or be banned. The clinician’s role is to advise and to record what is prescribed.

How the surveyor verifies this criterion

Sample. Review the banned-substance advice sheet and the advice and prescribing record for 5 athletes.

1. Athletes are advised on banned substances, with the list date recorded.

Method. Check each sampled athlete for the advice and the list date.

Evidence to show. Banned-substance advice and prescribing record (SPM-FRM-005).

Pass when. Every sampled athlete has the advice recorded with its list date.

2. Prescribing that may affect eligibility is checked.

Method. Check each prescription for the eligibility check.

Evidence to show. Banned-substance advice and prescribing record (SPM-FRM-005).

Pass when. Every eligibility-relevant prescription is checked and recorded.

3. The medicines rule applies to each prescription.

Method. Check the medicines management policy against the prescriptions.

Evidence to show. Medicines management policy (HOS-POL-001).

Pass when. Every prescription follows the policy.

Immediate fail (any one means the criterion is not met). A banned substance is prescribed with no check.

Staff responsible

Role Responsibility Level
Sports medicine physician (ISCO 2212) Advises athletes on banned substances Medium
Manager (ISCO 1342) Checks prescribing against the policy Medium

Documents: who does each step

Document Writes Approves Fills in Checks and signs Files and uploads
SPM-FRM-005 · Banned-substance advice and prescribing record Manager (ISCO 1342) Chief executive (ISCO 1120) Secretary (ISCO 3344) Manager (ISCO 1342) Secretary (ISCO 3344)
HOS-POL-001 · Medicines management policy Chief executive (ISCO 1120) Governing body members N/A Chief executive (ISCO 1120) Secretary (ISCO 3344)

E-learning: who must take each course

Course Who must take it
Medication Safety: Operating SOP-MED-01 End to End (T-08) Physician; Manager

References

In process of development. Will be available soon.

20.7Training Load and Injury Are ReviewedHumanitarian settings: MinimumTransition and fragile: MediumStandard: Must

Injury patterns and training load are reviewed, and action is taken to prevent further injury.

Humanitarian settings
Minimum
Transition and fragile
Medium
Standard
Must

Why it matters. Injuries in sport often come in patterns: the same athlete, the same training block, the same type of load. Reviewing those patterns and changing the training is how the next injury is prevented.

How the surveyor verifies this criterion

Sample. Review the injury and training load review for the last season, and the changes recorded.

1. Injury patterns are reviewed each season.

Method. Check the review record for the season.

Evidence to show. Injury and training load review register (SPM-REG-003).

Pass when. The season has a review recorded.

2. Training load is linked to injury in the review.

Method. Check each review for the link made.

Evidence to show. Injury and training load review register (SPM-REG-003).

Pass when. Every review links training load to injury.

3. Action is taken to prevent further injury, and its effect checked.

Method. Check each change for the effect recorded.

Evidence to show. Injury and training load review register (SPM-REG-003).

Pass when. Every change has its effect checked.

Immediate fail (any one means the criterion is not met). The same injury recurs in the same squad with no review.

Staff responsible

Role Responsibility Level
Manager (ISCO 1342) Reviews injury and training load each season Medium
Physiotherapist (ISCO 2264) Links training load to injury Medium

Documents: who does each step

Document Writes Approves Fills in Checks and signs Files and uploads
SPM-REG-003 · Injury and training load review register Secretary (ISCO 3344) Chief executive (ISCO 1120) Secretary (ISCO 3344) Manager (ISCO 1342) Secretary (ISCO 3344)

E-learning: who must take each course

Course Who must take it
Incident Reporting, Just Culture and Open Disclosure (T-09) Manager; Physician; Secretary

References

  1. World Health Organization (2025). Using the Package of Interventions for Rehabilitation in Georgia. Used for: functional review and recovery after injury, before a return decision. https://news.gmj.ge/guideline/using-the-package-of-interventions-for-rehabilitation-in-georgia/
20.8Suspected Head Injury Removes the Athlete From PlayHumanitarian settings: MustTransition and fragile: MustStandard: Must

An athlete with a suspected concussion or other head injury is removed from play at once. Return to play is not given on the day of injury. Return follows the staged plan in 20.2 and a documented clinical decision.

Humanitarian settings
Must
Transition and fragile
Must
Standard
Must

Why it matters. A blow to the head can cause a concussion that looks mild but gets worse if the athlete keeps playing. Removing the athlete at once, and not returning them the same day, prevents second-impact injuries that can be fatal.

How the surveyor verifies this criterion

Sample. Review the head injury removal and assessment records for the last 12 months, and the head injury protocol.

1. An athlete with a suspected head injury is removed from play at once.

Method. Check each record for the time of removal against the time of injury.

Evidence to show. Head injury removal and assessment record (SPM-FRM-006).

Pass when. Every suspected head injury is removed from play at once.

2. The athlete is assessed by a clinician.

Method. Check each record for the clinical assessment.

Evidence to show. Head injury removal and assessment record (SPM-FRM-006).

Pass when. Every removed athlete has a clinical assessment recorded.

3. No return is given on the day of injury, and return follows the staged plan.

Method. Check each return decision for the date and the plan followed.

Evidence to show. Head injury removal and assessment record (SPM-FRM-006).

Pass when. No return is given on the day of injury, and every return follows the staged plan.

Immediate fail (any one means the criterion is not met). An athlete with a suspected concussion is kept on the field.

Staff responsible

Role Responsibility Level
Sports medicine physician (ISCO 2212) Removes the athlete and assesses the head injury Must
Manager (ISCO 1342) Checks that no same-day return is given Must

Documents: who does each step

Document Writes Approves Fills in Checks and signs Files and uploads
SPM-FRM-006 · Head injury removal and assessment record Manager (ISCO 1342) Chief executive (ISCO 1120) Secretary (ISCO 3344) Manager (ISCO 1342) Secretary (ISCO 3344)

E-learning: who must take each course

Course Who must take it
Incident Reporting, Just Culture and Open Disclosure (T-09) Manager; Physician; Secretary

References

  1. National Institute for Health and Care Excellence (2023). Head injury: assessment and early management (NG232). Used for: assessment and removal from activity after a head injury, and transfer. https://news.gmj.ge/guideline/head-injury-assessment-and-early-management-ng232/

Who is responsible for Standard 20

Each criterion names the positions responsible for it. Every position links to its own terms of reference.

Criterion Responsible Supports
20.1 Each Athlete Has a Clinical Assessment Sports medicine physician Sports physiotherapist (fitness setting)
20.2 Return-to-Sport Decisions Are Staged and Documented Sports medicine physician
Sports physiotherapist (fitness setting)
Sports nutritionist
20.3 Pre-Participation Checks Are Done Where Required Sports medicine physician
General practitioner (GP)
Sports physiotherapist (fitness setting)
20.4 Staff Are Qualified for the Care They Give Sports medicine physician
Training and education manager
Competency assessor
20.5 Emergency Response for Sports Events Is Planned Sports medicine physician
Paramedic
Emergency medical technician (EMT)
20.6 Anti-Doping and Medicines Are Handled Correctly Pharmacist (dispensing)
Sports medicine physician
Chief pharmacist
20.7 Training Load and Injury Are Reviewed Sports physiotherapist (fitness setting)
Sports medicine physician
Occupational therapist
20.8 Suspected Head Injury Removes the Athlete From Play Sports medicine physician
Paramedic
General practitioner (GP)

Role details: reporting, supervision and training

Training shown is the general recommendation. Role-specific training is set in the next improvement round.

Role Reports to Supervises Recommended training
General practitioner (GP) Medical director None Facility induction; safeguarding adults (general recommendation)
Sports medicine physician Head of department (per specialty) None Facility induction; safeguarding adults (general recommendation)
Occupational therapist Head of department (per specialty) None Facility induction; safeguarding adults (general recommendation)
Chief pharmacist Medical director Clinical pharmacist, Pharmacist (dispensing), Pharmacy technician, Clinical trials coordinator Facility induction; safeguarding adults (general recommendation)
Pharmacist (dispensing) Chief pharmacist None Facility induction; safeguarding adults (general recommendation)
Paramedic Head of emergency department Emergency medical technician (EMT) Facility induction; safeguarding adults (general recommendation)
Emergency medical technician (EMT) Paramedic None Facility induction; safeguarding adults (general recommendation)
Training and education manager Chief human resources officer Training coordinator, Staff development officer, Competency assessor Facility induction; safeguarding adults (general recommendation)
Competency assessor Training and education manager None Facility induction; safeguarding adults (general recommendation)
Sports physiotherapist (fitness setting) Medical director None Facility induction; safeguarding adults (general recommendation)
Sports nutritionist Fitness club manager None Facility induction; safeguarding adults (general recommendation)

Questions and answers

The criterion text is the authority. These answers summarise it.

Who does Standard 58 apply to?

A provider that offers sports medicine: injury assessment and treatment, return-to-sport decisions, pre-participation checks and exercise-related health advice.

What do the colours mean for this standard?

Red (Must) is required. Green (Medium) is recommended. Yellow (Minimum) is the lowest acceptable level in humanitarian settings. Standard setting is Must on every criterion.

Why are 20.1, 20.5 and 20.8 red in humanitarian settings?

Each one protects a life: the red-flag referral, the emergency response at events, and the removal of an athlete with a suspected head injury. The other criteria are yellow in humanitarian settings.

Can an athlete return to play on the day of a head injury?

No. Under 20.8 the athlete is removed from play at once, and no return is given on the day of injury. Any later return follows the staged plan in 20.2.

Do I have to use the documents on this page?

No. The policies, SOPs, forms and registers are drafts to help you. Adapt them to your facility, write your own, or upload your own. What the assessor checks is that the criterion is met and that you can show how.

What does In process of development mean?

That part of the standard is still being prepared. It may be a document, a course, a reference or a role table. It will be added in a later version.

Guidelines for this standard

2 guideline(s) are held in the GMJ Guidelines Library and listed here. Each link opens the full guideline on news.gmj.ge. The complete library, grouped by standard, is at Guidelines.

  1. Cardiovascular Pre-participation Screening of Young Competitive Athletes: Proposal for a Common European Protocol (ESC)
  2. Head injury: assessment and early management (NG232) (National Institute for Health and Care Excellence (UK))

Also relevant to this standard: