PHYSICAL EDUCATION

I. PAR – Q TEST
The PAR-Q is a simple self-screening tool that is typically used by fitness trainers or coaches to
determine the safety or possible risks of exercising based on your health history, current
symptoms, and risk factors.

Questions Yes No
Have you ever been diagnosed with a heart condition with advice from a
1
doctor that you should only do physical activity recommended by them?
2 Do you feel pain in your chest when you do physical activity?
In the past month, have you had chest pain when you were not doing
3
physical activity?
4 Do you ever feel faint or have dizzy spells?
5 Do you have a joint problem that could be made worse by exercise?
6 Have you ever been diagnosed with high blood pressure?
Are you currently pregnant or have you had a baby in the last six months?
7
Are you currently taking any medication or have any medical conditions that
8 the instructor should be made aware of? If yes, please provide details:

If you have answered yes to one or more questions

Talk to your doctor by phone or in person before participating in physical activity. Tell your
doctor about the question(s) you have answered yes to. You may still be able to do any activity
you want - if you begin slowly and build up gradually - or you may need to limit your activities to
those which are safe for you. Talk with your doctor about the kind of activity you wish to
participate in and follow their advice.

If you have answered no to all questions

You can be reasonably confident that you can start to increase your physical activity and take
part in a progressive exercise program. Remember - begin slowly and build up gradually.

Your privacy
Why do we collect this information from you? We use the information here to assess your ability
to take part in a program of physical activity.

I have read, understood, and completed this questionnaire. All questions have been answered
to the best of my knowledge. I confirm I have completed the PAR - Q.

Name: ____________________________________

Signature: ________________________

Date: ________________________________