Department of Education

Region III-Central Luzon

Schools Division of Tarlac Province
PIT-AO ELEMENTARY SCHOOL

Physical Fitness Test Form

Student’s Profile

Name: ___________________________________________________________________________
Surname First Name M.I.
Date of Birth: ________________ Age: _____ Sex: _____
mm/dd/yyyy
Grade & Section: ________ Address: ______________________________________________
___________________________________________________________________________________________________

Pre-Test Post-Test
Date Date

PART I: HEALTH-RELATED FITNESS

A. Body Composition
Weight: _____/_______ Height: ______/_______ Waist Circumference: _____/______

B. Flexibility
Zipper Test: _____/_______ Sit and Reach: _______/________

C. Cardiovascular Endurance
3-minute STEP TEST: _____/______

D. Strength
90 degrees push- up: ______/______ Curl-Ups: ______/______

PART II: SKILL-RELATED FITNESS

A. Speed 40 Meter Sprint: ______/______

B. Power Basketball Pass: ______/_______

Standing Long Jump: _______/______

C. Agility Hexagon Agility Test: _______/_______

D. Reaction Time Stick drop Test: _____/______

E. Coordination Paper Juggling: ______/ _______

F. Balance Stork Balance Stand Test: ______/_______

Signed by:

__________________________________
PE Teacher