Republic of the Philippines

National Police Commission

PHILIPPINE NATIONAL POLICE, POLICE REGIONAL OFFICE 10
REGIONAL LEARNING & DOCTRINE DEVELOPMENT DIVISION
Camp 1Lt Vicente G Alagar, Cagayan de Oro City
Revised Form: 07-2020 (Form for 50 years old & below only) Running Number: ______________
(Fill-up this form properly! Incomplete Data, No PFT Results) Registration No.: 2024 -______ __
Date Taken: _____________ ____
PNP ID #: ______________ ___
Steps:
1. Registration: PSSg Giovanne C Gozalo
(Secretariat Name & Signature) BMI: _________________________

File Copy
2. Measurement: Weight to Lose: _________________
Height: _____ Weight: _____ Waistline:____ Wrist_____ BMI Category: ____________ _ _ __
Result: __________________ BMI Score: _____________________
3. BP: 1st BP: _____________ 2nd BP: ________________
4. ECG: __________________________________________
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 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
( ) 1.5k for 45-50 years old
Earned Performance REMARKS:
Points (EPP)
OVERALL PFT RESULT:

______________________________ Noted: ___________________________________

(Performer’s Signature) Name & Signature
Over-all event Supervisor (PNPTS)
===================================================================
Republic of the Philippines
National Police Commission
PHILIPPINE NATIONAL POLICE, POLICE REGIONAL OFFICE 10
REGIONAL LEARNING & DOCTRINE DEVELOPMENT DIVISION
Camp 1Lt Vicente G Alagar, Cagayan de Oro City

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

Full Name:

Date of Birth:
Last Name,

Performer's
Age:
First Name, M.I. Rank

PNP Badge Number:

Sex

REMARKS:
Copy
Office: (Print Complete Office/Unit Assignment)

Registration Number: 2024 -__________

OVERALL PFT RESULT:

_______________________________ Noted: __________________________________

(Performer’s Signature) Name & Signature
Over-all event Supervisor (PNPTS)