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: 07-2023 (Form for 50 years old & below) Running #: ___________________
(Fill-up this form properly! Incomplete Data, No PFT Results) Registration #: ___________
Date Taken: ________________
PNP ID #: ________________

Steps:

PFT:
1. Registration: ________________________
(Secretariat Name & Signature)
2. Measurement:
Height: ______ Weight: _______ Waistline: _______ BMI: ______________________

CY
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:

Date of Birth:
Last Name,

Age:
First Name,
2023
M.I. Rank

PNP Badge Number:

Sex

Office: (Print Complete Office/Unit Assignment)

Events Raw Score Rating Member/Scorer’s Name & Team Leader’s Name &
Signature (PNCO) Signature (PCO)
Sit-up (1 minute)

Push-up (1 minute)
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: 07-2023 (Form for 50 years old & below)
(Fill-up this form properly! Incomplete Data, No PFT Results)
Running #: ____________________
Date Taken: _______________
PNP ID #: _______________

Full Name:

Date of Birth:
Last Name,

CopyAge:
First Name, M.I. Rank

PNP Badge Number:

Sex

REMARKS:
PFT: CY 2023
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)