PHYSICAL FITNESS TEST

PSFTP CL 2020-01

Date Taken: __________________

Steps:
1. MEASUREMENT: Examiner’s Name/Initial:
Height: ________ Weight: _________ Waistline:___________ _____________________________
Chest: _____________ Result:_______________________

2. BP: 1st BP ______________ 2nd BP _____________ _____________________________

3. GO / No GO: ___________________________________
(Physicians Signature)

PHYSICAL FITNESS TEST FORM (Please write legibly)

Print Full Name: Last Name, First Name, MI RANK SEX

DATE OF BIRTH: AGE: PNP Badge Number:

OFFICE: (PSFTP TRAINING VENUE)

RAW REMARKS SCORER’S NAME

EVENTS RATING
SCORE Passed Failed & Signature
Pull-up/Hang

Sit-up

Push-up

Broad Jump

100 M Sprint

Jog (3 km)

TOTAL

_____________________________
(Examinee’s Signature)
Noted by:
____________________________
PMAJ CARLO C JURINARIO
Assistant Training Manager