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Republic of the Philippines

Department of the Interior and Local Government


BUREAU OF FIRE PROTECTION
REGIONAL OFFICE 11
Leon Garcia cor. Monteverde St., Davao City

NAME: _____________________________________________ DATE: ___________________________

AGE: ________ SEX: _________ Total Points: ______________ Passed: Failed:

CONDUCTED BY: REMARKS:

_____________________________

1. MEDICAL

BP: _______________ Passing Scores:

HEIGHT: _______________ Men: 75%


WEIGHT: _______________ Women: 75%

EVENTS NO. OF ACTIVITIES POINTS


1. Pull-Ups (Male)
2. Full Arms Hanging (Female)
3. Push-Ups
4. Sit-Ups
5. Flatter Kicks
6. Endurance run (3km) (Male)
7. 100 -meter run (Female)
8. Pick-up and Carry on Shoulder (Male) (not included)
a. 2.5 diameter hose (dry)
b. 50 kilograms hose (dry)
9. Pick-up and Carry on Shoulder (Female) (not included)
a. 1.5” diameter hose
b. 25 kilograms hose (dry)
TOTAL POINTS

________________________________________
Signature of Applicant

Conducted by: Noted by:

____________________________________ ________________________________
Chairperson, PAT Committee

BFP-QSF-HRMD-011 Rev. ØØ (05.04.18)

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