PFT Form Revised 11
PFT Form Revised 11
PFT Form Revised 11
2. MEASUREMENT:
Examiners Name/Initial:
___________________________
Result: ______________________
(Obese Over 15 lbs)
3. BP: 1st BP __________2nd BP_________________
___________________________
4. ECG: ____________________________________
5. GO / No GO: _____________________________
(Physicians Signature)
PHYSICAL FITNESS TEST FORM (Revised 2006) (Please write legibly)
Print Full Name: Last Name,
First Name,
MI
RANK
DATE OF BIRTH: (Month/Day/Year)
AGE:
SEX
EVENTS
RAW
SCORE
RATING
REMARKS
Passed
Failed
SCORERS NAME
& Signature
______________________
(Examinees Signature)
Noted by:
__________________
(Designated Supervisor)
NOTE: 1. Bring your PNP ID;
2. The attire shall be PNP athletic uniform blue t-shirt and dark blue shorts/jogging pants with PULIS markings.
3. The performer/examinee will sign the receive copy after performing all the events.
(HRDD/STU, RPHRDD will not issue a copy of lost PFT result)
HRDD/STU PRO6
2. MEASUREMENT:
Examiners Name/Initial:
___________________________
Result: ______________________
(Obese Over 15 lbs)
3. BP: 1st BP __________2nd BP_________________
___________________________
4. ECG: ____________________________________
5. GO / No GO: _____________________________
(Physicians Signature)
PHYSICAL FITNESS TEST FORM (Revised 2006) (Please write legibly)
Print Full Name: Last Name,
First Name,
MI
RANK
DATE OF BIRTH: (Month/Day/Year)
AGE:
SEX
EVENTS
RAW
SCORE
RATING
REMARKS
Passed
Failed
SCORERS NAME
& Signature
______________________
(Examinees Signature)
Noted by:
HRDD/STU PRO6
2. MEASUREMENT:
Examiners Name/Initial:
___________________________
Result: ______________________
(Obese Over 15 lbs)
3. BP: 1st BP __________2nd BP_________________
___________________________
4. ECG: ____________________________________
5. GO / No GO: _____________________________
(Physicians Signature)
PHYSICAL FITNESS TEST FORM (Revised 2006) (Please write legibly)
Print Full Name: Last Name,
First Name,
MI
RANK
DATE OF BIRTH: (Month/Day/Year)
AGE:
SEX
RAW
SCORE
RATING
REMARKS
Passed
Failed
SCORERS NAME
& Signature
_________________________
(Examinees Signature)
Noted by:
___________________________
(Designated Supervisor)
HRDD/STU PRO6