QUARTER 1 MODULE 3

ACTIVITY SHEET
PHYSICAL EDUCATION 11

HEALTH APPRAISAL RECORD

(SUBMIT A PDF)

I. PERSONAL DATA:

Name: Fretcziel Heart T. Pandan Gender: Female Age: 16

II. PHYSICAL AND MEDICAL EXAMINATION

Height: 5’2 Weight: 53 kg
Resting Pulse Rate: 86 Blood Type:
Date of Last Medication: 11/23/2016

III. QUESTIONAIRE:
To be further of assistance to you, please answer and/or check the answer of
the following questions. Any hospitalization/surgery since the last medical
examination? (YES)___ (NO)__if YES, please indicate nature of
injury/injuries?___________________
1. Any injury sustained last medical examination? YES___NO__
What was the nature of injury/injuries? __________________
2. Have you had any of the following:
a. Chest pain or difficulty of breathing on physical exertion? YES___NO _
b. Frequent dizziness or fainting spells? YES___NO___
c. Asthma? YES___NO__
d. Other lung disease? YES___NO__
e. Diabetes? YES___NO__
f. High Blood Pressure? YES___NO__
g. Anemia? YES___NO__
h. Kidney Trouble/Disease? YES__NO___
i. Arthritis? YES___NO__
j. Gout? YES___NO__
k. Dislocation? YES___NO__
If yes, please indicate what part of the body__________
j. Fractures? YES___NO__
3. At present, do you have lumbar/lower back pain? YES___NO__
4. Other ailments which you have at present that may in a way restrict your
physical activity? Please specify NONE.
5. Are you now under treatment? YES__NO___
6. Do you engage in regular exercises? YES___NO__
7. How often do you exercise? I only exercise sometimes.
8. How long do you exercise? At least once a week.
9. When was the last time you exercise? A week ago.
10. Do you smoke? YES___NO__
11. Do you drink alcohol beverages? YES___NO__ if yes, how often______
I certify as to the correctness of the answers to the above questions.

FRETCZIEL HEART T. PANDAN

Name and Signature of Students Date

MARY JANE T. PANDAN

Name and Signature of Parent Date
Self-Assessment Card: Health-related fitness Status Name: Fretcziel Heart T. Pandan
Age: 16 Sex: Female
Weight: 53 Height: 5’2
Classification
HEALTH RELATED SCORE Analysis/implication
FITNESS TEST
BMI 20.7 Normal
Waist Hip Ratio 0.84 Average
3-minute step test 67 bpm Excellent
Push-Up 15 Marginal Zone
Curl-up 12 Low Zone
Flex arm 10-seconds
Flexibility 16 cm Average
Zipper Test 14 cm - Right Excellent - Right
13 cm - Left Excellent - Left

Activity 3. Let’s Analyze!

Answer the following Questions below based from the result of your self-assessment
card.
1. What is your strongest HRF Component?
- Zipper Test

2. What is your weakest HRF component?

- Flex arm

3. Which test did you score satisfactory? Poorly? What you should do about it?
- I score satisfactory in Zipper Test while I score poorly in Flex arm. I should try to
improve my arm so that I can manage lifting my weight and also do exercise from
now on.

4. How important is HRF in participating physical activity?

- It is very important because it includes value, knowledge, skills and experiences in
physical activity participation in order to achieve and maintain health-related fitness
(HRF) as well as optimize health.

5. Why is Health related fitness test important in designing exercise program?

- Because the test is used as a starting point for building a suitable exercise program
for general health and fitness. They’re designed to keep you safe and give your
trainer the information he or she needs to set clear and effective training goals.