Republic of the Philippines

Department of Education
Region V
Masbate City Division
MASBATE NATIONAL COMPREHENSIVE HIGH SCHOOL
Masbate City

Additional Activity: Fitness Self-Assessment

Name: EMERICH R. VELASCO Grade & Section: 9 B-Pascal (STEM) Date: ________
Date of Birth: January 20, 2006 Gender: Female Age: 14 yrs old
PART I: HEALTH RELATED FITNESS TEST
A. BODY COMPOSITION:
1. Body Mass Index (BMI)
WEIGHT (kg) HEIGHT (m) BMI CLASSIFICATION

40 kg 149 m 18 underweight

B. CARDIOVASCULAR ENDURANCE:
1. 3 Minute Step Test
HEART RATE PER MINUTE

BEFORE THE ACTIVTY AFTER THE ACTIVITY RECOVERY

63 141 69

C. STRENGTH:
1. Push-up 2. Plank
NUMBER OF PUSH UPS

10

TIME

58 seconds

D. FLEXIBILITY:
1. Zipper Test 2. Sit and Reach

OVERLAP/GAP (cm)

RIGHT LEFT

OVERLAP GAP OVERLAP GAP

6 4

SCORE (cm)

FIRST SECO BEST

TRY ND SCORE
TRY

73 85 89

PART II: SKILL RELATED FITNESS TEST

A. COORDINATION:
1. Juggling
SCORE

3
 B. AGILITY:
1. Hexagon Agility Test
CLOCKWISE TIME COUNTER CLOCKWISE TIME AVERAGE

2.82 sec 2.23 sec 6.19 sec

C. SPEED:
1. 40 m Sprint
TIME

10 sec

D. POWER:

1. STANDING LONG JUMP

DISTANCE (cm)

FIRST TRIAL SECOND TRIAL

145 161

E. BALANCE:
1. Stork Balance Stand Test
RIGHT FOOT: TIME (0:00) LEFT FOOT: TIME (0:00)

1.59.39 sec 1.02.93 sec

F. REACTION TIME:
1. Stick Drop Test
FIRST TRIAL SECOND TRIAL MIDDLE SCORE

10 cm 12 cm 12 cm

Prepared by:
MAPEH TEACHERS