HEALTH ASSESSMENT CARD

Name: ________________________________________ Date: ________________

Year/Section: __________________________________

Directions : Fill up necessary information needed. Interpretations will be based on the

chart. Complete the column for analysis/implications in two or three sentences only.

1. ANTROPOMETRIC MEASUREMENT

TEST BMI RESULT ANALYSIS

INTERPRETATION
BMI

WAIST HIP RATIO (cm) Waist =

W(cm) / H (cm) Hip =

WAIST TO HIP RATIO MEN WOMEN

Ideal 0.8 0.7
Low Risk <0.95 <0.8
Moderate Risk 0.96 – 0.99 0.81 – 0.84
High Risk >1.0 >0.85
MUSCULAR STRENGTH
Mark with a dot the performance description obtained and connect the dots. (use color
blue ballpen)

HIGH

GOOD

MARGINAL

LOW

PUSH UP CURL UPS

SCORES: ________________ _________________

ENDURANCE, FLEXIBILITY

HIGH

GOOD

MARGINAL

LOW

ZIPPER TEST SIT AND REACH FLEXED ARM SUPPORT

L R

SCORES: _______ _______ ____________ __________________

 RATING SCALE FOR DYNAMIC MUSCULAR ENDURANCE
Age 16 – 26 Male Female
Curl – ups Push – ups Curl – ups Push – ups
High Can do more Can do more Can do more Can do more
Performance than 35 than 29 than 25 than 17
Zone
Good Fitness 24 – 34 20 – 28 18 – 24 12 – 16
Zone
Marginal Zone 15 – 23 16 – 19 10 – 17 8 – 11
Low Zone 14 and below 15 and below 9 and below 7 and below

RATING SCALE FOR STATIC ENDURANCE (FLEXED ARM SUPPORT)

CLASSIFICATION SCORE IN SECONDS
High – performance zone 30 and above
Good fitness zone 20 – 29
Marginal zone 10 – 19
Low zone 10

RATING SCALE FOR FLEXIBILITY

CLASSIFICATION MALE MALE FEMALE FEMALE
Shoulder Sit and Shoulder Sit and
Flexibility Reach Flexibility Reach
(Zipper test) (Zipper test)
High R L 16+ R L 17+
Performance 5+ 4+ 6+ 5+
Zone
Good Fitness 1–41–3 13-15 2–52–4 14-16
Zone
Marginal Zone 0 0 10-12 1 1 11-13
Low Zone <0 <0 <9 <1 <1 <10
CARDIOVASCULAR ENDURANCE
3 – MINUTE STEP TEST RECOVERY PR & INTERPRETATION TEST BMI
RESULT

ANALYSIS= RHR =
HR =

RATING SCALE FOR CARDIOVASCULAR ENDURANCE

CLASSIFICATION SCORE IN SECONDS
High – performance zone 52-95
Good fitness zone 96-112
Marginal zone 113-134
Low zone 135-169
MY STRONGER HRF COMPONENT: ______________________________________
MY WEAKNESS HRF COMPONENT: ______________________________________

REALIZATION / CONCLUSION:
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This is to acknowledge and certify that the data provided herein are true and
correct.

______________________________________
Signature over printed name/ Date
Student

PROFESSOR MONICA LAURA CHAVEZ, LPT