Republic of the Philippines

NATIONAL POLICE COMMISSION

PHILIPPINE NATIONAL POLICE TRAINING SERVICE
Regional Special Training Unit MIMAROPA
Sitio Ibong, Brgy. Pag-asa, Bansud, Oriental Mindoro

Revised Form: 01-2020 (Form for 50 years old & below only) Running Number: ________________
(Fill-up this form properly! Incomplete Data, No PFT Results) Registration No: ________________
Date Taken: ________________
PNP ID #: ________________
Steps:
1. Registration: PSSg Rechelle M Escarez

2. Measurement:
(Secretariat Name & Signature)
PFT: CY 2022
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

Date of Birth: Age: File Copy Sex PNP Badge Number:

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) PCpl Lily Ann S Lumanta PEMS Alpha G Delos Santos

Push-up (1 minute) PCpl Lily Ann S Lumanta PEMS Alpha G Delos Santos
300 Meter Sprint
(for 34 years old & below only) PCpl Mark Joseph R Alquisar PEMS Alpha G Delos Santos
Kilometer Run
( ) 3k for 34 years old & below
( ) 2k for 35-44 years old
( ) 1.5k for 45-50 years old PSSg Melvin R Vicente PEMS Alpha G Delos Santos
Earned Performance Points (EPP) REMARKS:
OVERALL PFT RESULT:

____________________________
(Performer’s Signature) Noted: PCOL ROMIE A ESTEPA
Name & Signature
Over-all event Supervisor (RSTU)
================================================================
Republic of the Philippines
NATIONAL POLICE COMMISSION
PHILIPPINE NATIONAL POLICE TRAINING SERVICE
Regional Special Training Unit MIMAROPA
Sitio Ibong, Brgy. Pag-asa, Bansud, Oriental Mindoro

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

Full Name: Last Name, First Name, M.I. Rank Badge Nr

Date of Birth: Age: Sex: Email Add:

Performer's
Office: (Print Complete Office/Unit Assignment)

REMARKS: Registration Number:

OVERALL PFT RESULT:

______________________________
Copy
(Performer’s Signature) Noted: PCOL ROMIE A ESTEPA
Name & Signature
Over-all event Supervisor (RSTU)