Head Injuries & Concussions

A hit to the head from a fall, a falling object or a piece of equipment can injure the brain, even when the worker seems fine afterward. Symptoms of a concussion or bleeding in the brain can show up minutes, hours or even days later. Never let a coworker “shake it off” and go back to work.

• Construction
• General Industry
• Home

Types of head injuries

• Concussion: a mild traumatic brain injury (TBI) caused by a bump, blow or jolt that makes the brain move inside the skull. You don’t have to be knocked out to have a concussion.
• Bleeding in or around the brain: can cause pressure on the brain that gets worse over hours. Life-threatening.
• Skull fracture: a break in the skull bone, sometimes with a visible dent or wound.
• Scalp wounds: bleed heavily because the scalp has many blood vessels, but they may hide a more serious injury underneath.

Common causes at work

• Falls from ladders, scaffolds, roofs and equipment, and falls on the same level
• Tools and materials falling from above
• Being struck by swinging loads, equipment or vehicles
• Hitting your head on beams, pipes, ducts and low ceilings
• Vehicle crashes

Signs of a concussion

Danger signs: call 911

• Lost consciousness, even briefly
• A headache that gets worse and won’t go away
• Repeated vomiting
• Seizures or convulsions
• One pupil (the black center of the eye) larger than the other
• Slurred speech, weakness, numbness or poor coordination
• Very drowsy or can’t be woken up
• Increasing confusion, restlessness or strange behavior
• Clear fluid or blood from the nose or ears
• A visible dent, deep wound or object stuck in the head
• A fall from height or a high-energy impact, even if they seem OK

First aid

1. Check the scene for ongoing hazards, then call 911 if any danger sign is present.
2. Assume a neck or back injury after a fall or strong impact. Keep the head and neck still, in the position you found them. Don’t remove the hard hat unless it’s blocking breathing or CPR.
3. Check breathing. If they’re not breathing normally, start CPR. See CPR & AEDs.
4. Control bleeding with gentle pressure using a clean dressing. If you feel a dent or bone pieces, press lightly around the edges, not on the wound.
5. Don’t remove anything stuck in the head. Stabilize it with bulky dressings.
6. If they vomit, roll them onto their side while keeping the head, neck and body in line (get help if you can).
7. Stay with them and watch for changes until EMS arrives. Note the time of injury and any loss of consciousness.

Even if they seem fine

• Stop work. Anyone with a suspected concussion should not keep working that day, especially at heights or around equipment.
• Have them checked by a medical provider the same day.
• Don’t let them drive.
• Make sure someone stays with them for the next several hours and watches for danger signs.
• Report the injury. See Reporting Injuries.

Recovering and returning to work

• Most people recover from a concussion in days to a few weeks, but some have symptoms for months.
• Rest for the first day or two, then return to light activity as your provider advises.
• Avoid another head injury while you recover. A second concussion before the first heals can be much more serious.
• Ask about modified duty if you have headaches, dizziness or trouble concentrating. Working at height or running equipment with these symptoms isn’t safe. See Fitness for Duty.
• Tell your provider if symptoms last or get worse. Workers’ compensation generally covers treatment for work-related head injuries. See Workers’ Compensation.

Preventing head injuries

• Wear your hard hat whenever there’s overhead work, falling object hazards or bump hazards. Consider a Type II helmet, which protects against side impacts, and use the chin strap when working at height. See Hard Hats.
• Replace a hard hat after any significant impact, even if it looks fine.
• Prevent falls with guardrails, covers and fall arrest. See Fall Protection Basics.
• Tether tools at height and keep drop zones barricaded.
• Mark and pad low beams, pipes and ducts.
• Keep walkways clear to prevent slips and trips.

Last updated: October 1, 2026