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    Blanko kesamaptaan

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    BLANKO KESJAS

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    Blanko kesamaptaan

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
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    142 views1 page

    Blanko Kesjas

    Uploaded by

    Oppo Reno4F
    Blanko kesamaptaan

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 1

    BIRO PERAWATAN PERSONEL POLRI

    BAGIAN PEMBINAAN JASMANI


    NO. DADA : ……………
    PRIA / WANITA : ……………

    FORMULIR TES KESAMAPTAAN JASMANI T.A. 2020


    1. N a m a : …………………………………………………………………………………………………………...
    2. Pangkat / Nrp / Nip : ……………………………………………………………………………………………………………
    3. Tanggal lahir/Umur/Gol : …………………………………………………………………………………………..………………
    4. Tinggi / Berat Badan : ……………………….………..………Cm / ………………..……………………………………..Kg
    5. Jabatan : …………………………………………..……………………….………………………………………
    6. Kesatuan : ……………………………………..…………………………………….………………………………

    TES SAMAPTA “ A “ :
    LARI 12 MENIT : …………………………METER NILAI : ……………………….........
    Catatan Tes Samapta “ A “ :
    Keliling : 1 2 3 4 5 6 7 8 9 10 11 12 13 14 Berhenti pada jarak : …………
    TES SAMAPTA “ B “ :

    NO ITEM TES HASIL GERAK / WAKTU NILAI


    1. PULL – UPS …………………………………. …………….…………………
    2. SIT – UPS …………………………………. ……….………………………
    3. PUSH – UPS …………………………………. ……….………………………
    4. SHUTTLE RUN …………………………………. ……….………………………
    JUMLAH : ……….………………………
    RATA – RATA : ……….………………………

    NILAI AKHIR = NILAI “A” + NILAI “B” = ______________ + ______________ =


    2

    BIRO PERAWATAN PERSONEL POLRI


    BAGIAN PEMBINAAN JASMANI
    NO. DADA : ……………
    PRIA / WANITA : ……………

    FORMULIR TES KESAMAPTAAN JASMANI T.A. 2020

    1. N a m a : …………………………………………………………………………………………………………...
    2. Pangkat / Nrp / Nip : ……………………………………………………………………………………………………………
    3. Tanggal lahir/Umur/Gol : ……………………………………………………………………………………..……………………
    4. Tinggi / Berat Badan : ……………………….………….………Cm / ………………..…………………… ……………..Kg
    5. Jabatan : …………………………………………..………………………………………………………………
    6. Kesatuan : ……………………………………..……………………………………………………………………

    TES SAMAPTA “ A “ :
    LARI 12 MENIT : …………………………METER NILAI : ……………………….........
    Catatan Tes Samapta “ A “ :
    Keliling : 1 2 3 4 5 6 7 8 9 10 11 12 13 14 Berhenti pada jarak : …………
    TES SAMAPTA “ B “ :

    NO ITEM TES HASIL GERAK / WAKTU NILAI


    1. PULL – UPS …………………………………. …………….…………………
    2. SIT – UPS …………………………………. ……….………………………
    3. PUSH – UPS …………………………………. ……….………………………
    4. SHUTTLE RUN …………………………………. ……….………………………
    JUMLAH : ……….………………………
    RATA – RATA : ……….………………………
    NILAI AKHIR = NILAI “A” + NILAI “B” = ______________ + ______________ =
    2

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