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PNP PHYSICAL FITNESS TEST FORM

2nd Semester CY 2012


Revised Form:
(Fill-up this form completely! Incomplete Data, No PFT Results)
Running No.____________________
Date Taken: ____________________
Steps:
1. REGISTRATION:

PNP ID Number: _______________


__________________________
(Secretariat Name/Initial)

2. MEASUREMENT:

Examiners Name/Initial:

Height:_______ Weight: ________ Waistline:_______

___________________________

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

PNP Badge Number:

OFFICE ( Print Complete Office/Unit Assigned)

EVENTS

RAW
SCORE

RATING

REMARKS

Passed

Failed

SCORERS NAME
& Signature

Pull-up (for 44 years and below only)


Push-up
Sit-up
100 M Sprint for 34 years old and below only)

Jog/walk (3 Km for 34 years old and below)


( 2 Km for 35-44 years old)
( 1 Km for 45 years old and above)

______________________
(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

PNP PHYSICAL FITNESS TEST FORM


1st Semester CY 2010
Revised Form:
(Fill-up this form completely! Incomplete Data, No PFT Results)
Running No.____________________
Date Taken: ____________________
Steps:
1. REGISTRATION:

PNP ID Number: _______________


__________________________
(Secretariat Name/Initial)

2. MEASUREMENT:

Examiners Name/Initial:

Height:_______ Weight: ________ Waistline:_______

___________________________

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

PNP Badge Number:

OFFICE ( Print Complete Office/Unit Assigned)

EVENTS

RAW
SCORE

RATING

REMARKS

Passed

Failed

SCORERS NAME
& Signature

Pull-up (for 44 years and below only)


Push-up
Sit-up
100 M Sprint for 34 years old and below only)

Jog/walk (3 Km for 34 years old and below)


( 2 Km for 35-44 years old)
( 1 Km for 45 years old and above)

______________________
(Examinees Signature)
Noted by:

PSINSP DANTE S TAYCO


OIC, HRDD/STU, PRO6
(Designated Supervisor)

(NOTE: BRING YOUR PNP ID; NO PNP ID, NO PFT)

HRDD/STU PRO6

PNP PHYSICAL FITNESS TEST FORM


2ND Semester CY 2008
Revised Form:
(Fill-up this form completely! Incomplete Data, No PFT Results)
Running No.____________________
Date Taken: ____________________
Steps:
1. REGISTRATION:

PNP ID Number: _______________


__________________________
(Secretariat Name/Initial)

2. MEASUREMENT:

Examiners Name/Initial:

Height:_______ Weight: ________ Waistline:_______

___________________________

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

PNP Badge Number:

OFFICE ( Print Complete Office/Unit Assigned)


EVENTS

RAW
SCORE

RATING

REMARKS

Passed

Failed

SCORERS NAME
& Signature

Pull-up (for 44 years and below only)


Push-up
Sit-up
100 M Sprint for 34 years old and below only)

Jog/walk (3 Km for 34 years old and below)


( 2 Km for 35-44 years old)
( 1 Km for 45 years old and above)

_________________________
(Examinees Signature)
Noted by:

___________________________
(Designated Supervisor)

(NOTE: BRING YOUR PNP ID; NO PNP ID, NO PFT)

HRDD/STU PRO6

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