Activity Sheet No.

10
Measure individual’s Health and Skill related Component through
Physical Fitness Test

Test Component
Station Score Date Tester Instructor
Items of Fitness
Modified-
Clarisa J. Centhony
1 Side Leg Balance Aug. 23
Etom L. Amil
Extension
Sit and Trunk Clarisa J. Centhony
2 Aug. 23
Reach Flexibility Etom L. Amil
Abdominal
Clarisa J. Centhony
3 Curl-up Strength/ Aug. 23
Etom L. Amil
Endurance
Regular
Arm
Push- Clarisa J. Centhony
4 Strength/ Aug. 23
ups/Knee Etom L. Amil
Endurance
push-ups
Standing Leg
Long Strength/ Clarisa J. Centhony
5 Aug. 23
Jump Power/ Etom L. Amil
Test Endurance
Clarisa J. Centhony
6 T- Test Agility Aug. 23
Etom L. Amil

Rubric:
Range/
Poor Very Poor Average Good Very Good
Points
2 4 6 8 10

Performs the Performs the Performs the Performs the Performs the
required required required required required
exercises in exercises in exercises in exercises in exercises in very
Fitness poor range or very poor average range good range or good range or
Test with 1 -20 % range or with or with 41 -60 with 61 -80 % with 81 -100 %
score. 21 - 40 % % score. score. score.
score.

Tabulating and Scoring

Stations
Name
1 2 3 4 5 6
10 8
Station 1: Stork Balance Stand
Intervals Description
= (Highest-Lowest)/5 _____ to _____ Very Poor 2
= (_____-_____)/5 _____ to _____ Poor 4
=_____/5 _____ to _____ Average 6
=_____ _____ to _____ Good 8
_____ to _____ Very Good 10
Station 2: Sit and Reach
Intervals Description
= (Highest-Lowest)/5 _____ to _____ Very Poor 2
= (_____-_____)/5 _____ to _____ Poor 4
=_____/5 _____ to _____ Average 6
=_____ _____ to _____ Good 8
_____ to _____ Very Good 10
Station 3: Curl-up
Intervals Description
= (Highest-Lowest)/5 _____ to _____ Very Poor 2
= (_____-_____)/5 _____ to _____ Poor 4
=_____/5 _____ to _____ Average 6
=_____ _____ to _____ Good 8
_____ to _____ Very Good 10
Station 4: Push-ups
Intervals Description
= (Highest-Lowest)/5 _____ to _____ Very Poor 2
= (_____-_____)/5 _____ to _____ Poor 4
=_____/5 _____ to _____ Average 6
=_____ _____ to _____ Good 8
_____ to _____ Very Good 10
Station 5: Standing Long Jump
Intervals Description
= (Highest-Lowest)/5 _____ to _____ Very Poor 2
= (_____-_____)/5 _____ to _____ Poor 4
=_____/5 _____ to _____ Average 6
=_____ _____ to _____ Good 8
_____ to _____ Very Good 10
Station 6: Illinois Agility Test (Note: Reverse score
input)
Intervals Description
= (Highest-Lowest)/5 _____ to _____ Very Poor 2
= (_____-_____)/5 _____ to _____ Poor 4
=_____/5 _____ to _____ Average 6
=_____ _____ to _____ Good 8
_____ to _____ Very Good 10

Stations:
1 Stork Stand _____
2 Sit and Reach _____
3 Curl-up _____
4 Push-ups _____
5 Standing Long Jump _____
6 Illinois Agility Test _____

Total Score: ______