Republic of the Philippines

NATIONAL POLICE COMMISSION

PHILIPPINE NATIONAL POLICE TRAINING SERVICE
Regional Special Training Unit 4A
Camp BGen Vicente P Lim, Calamba City, Laguna

Revised Form: 07-2020 (Form for 50 years old & below only) Running #: ___________________
(Fill-up this form properly! Incomplete Data, No PFT Results) Registration #: ___________
Date Taken: ________________
PNP ID #: ________________

Steps:
1. Registration: ________________________
(Secretariat Name & Signature)
2. Measurement:
Height: ______ Weight: _______ Waistline: _______ BMI: ______________________
Result: __________________ Weight to lose: ______________
3. BP: 1st BP: _____________ 2nd BP: ________________ BMI Category: _______________
4. ECG: __________________________________________ BMI Score: __________________
5. GO / No GO: __________________________________
(Physician Name & Signature)

Full Name: Last Name, First Name, M.I. Rank Sex

Date of Birth: Age: PNP Badge Number:

Office: (Print Complete Office/Unit Assignment)

Events Raw Score Rating

PFT:
Member/Scorer’s Name & Team Leader’s Name &

CY
Signature (PNCO) Signature (PCO)
Sit-up (1 minute)

Push-up (1 minute)

2022
300 Meter Sprint
(for 34 years old & below only)
Kilometer Run
( ) 3k for 34 years old & below
( ) 2k for 35-44 years old
( ) 1k for 45 years old & above

Earned Performance Points (EPP) REMARKS:

OVERALL PAT RESULT:

______________________________
(Performer’s Signature) Noted: PCOL ERWIN B BALIGNASAY
Name & Signature
Over-all Event Supervisor
(RSTU4A)
===============================================================================

Republic of the Philippines

NATIONAL POLICE COMMISSION
PHILIPPINE NATIONAL POLICE TRAINING SERVICE
Regional Special Training Unit 4A
Camp BGen Vicente P Lim, Calamba City, Laguna

Performer's
Revised Form: 01-2020 (Form for 50 years old & below only)
(Fill-up this form properly! Incomplete Data, No PFT Results)
Running #: ____________________
Date Taken: _______________
PNP ID #: _______________

Full Name:

Date of Birth:
Last Name,

Copy Age:
First Name, M.I. Rank

PNP Badge Number:

Sex

REMARKS:
PFT: CY 2022
Office: (Print Complete Office/Unit Assignment)

Control Number: __________________

OVERALL PAT RESULT:

______________________________
(Performer’s Signature) Noted: PCOL ERWIN B BALIGNASAY
Name & Signature
Over-all Event Supervisor
(RSTU4A)