Activity Sheet No.

10
Measure individual’s Health and Skill related Component through
Physical Fitness Test

Test Component
Station Score Date Tester Instructor
Items of Fitness
Modified-
1 Side Leg Balance
Extension
Sit and Trunk
2
Reach Flexibility
Abdominal
3 Curl-up Strength/
Endurance
Regular
Arm
Push-
4 Strength/
ups/Knee
Endurance
push-ups
Leg
Vertical
Strength/
5 Jump
Power/
Test
Endurance

6 T- Test Agility

Rubric:

Range/
Poor Very Poor Average Good Very Good
Points
2 4 6 8 10
Performs the Performs the Performs the Performs the Performs the
required required required required required
exercises in exercises in exercises in exercises in exercises in very
Fitness poor range or very poor average range good range or good range or
Test with 1 -20 % range or with or with 41 -60 with 61 -80 % with 81 -100 %
score. 21 - 40 % % score. score. score.
score.

Tabulating and Scoring

Name 1 2 3 Stations 4 5 6
Station 1: Stork Balance Stand
Intervals Description
= (Highest-Lowest)/5 to Very Poor 2
=( - )/5 to Poor 4
= /5 to Average 6
= to Good 8
to Very Good 10
Station 2: Sit and Reach
Intervals Description
= (Highest-Lowest)/5 to Very Poor 2
=( - )/5 to Poor 4
= /5 to Average 6
= to Good 8
to Very Good 10
Station 3: Curl-up
Intervals Description
= (Highest-Lowest)/5 to Very Poor 2
=( - )/5 to Poor 4
= /5 to Average 6
= to Good 8
to Very Good 10
Station 4: Push-ups
Intervals Description
= (Highest-Lowest)/5 to Very Poor 2
=( - )/5 to Poor 4
= /5 to Average 6
= to Good 8
to Very Good 10
Station 5: Standing Long Jump
Intervals Description
= (Highest-Lowest)/5 to Very Poor 2
=( - )/5 to Poor 4
= /5 to Average 6
= to Good 8
to Very Good 10
Station 6: Illinois Agility Test (Note: Reverse score
input)
Intervals Description
= (Highest-Lowest)/5 to Very Poor 2
=( - )/5 to Poor 4
= /5 to Average 6
= to Good 8
to Very Good 10

Stations:
1 Stork Stand
2 Sit and Reach
3 Curl-up
4 Push-ups
5 Standing Long Jump
6 Illinois Agility Test

Total Score: