SENIOR HIGH SCHOOL DEPARTMENT

Physical Education and Health Grade 11

A.Y. 2022-2023
PHYSICAL FITNESS TEST
Individual Score Sheet

PERSONAL INFORMATION
Name: Section: Group: Birthdate:
Address: Age: Blood type:

MEDICAL RECORD/HISTORY:
Allergies (describe): to
Major Illnesses/Surgery:
History of illnesses in the family: work harder.’’
ANTHROPOMETRIC TEST:
BMI RATING CHART
Height: Indicator Men Women
Underweight <20 <19
Weight: Healthy Range 20-25 19-24
Overweight 26-30 25-30
Evaluation: Obese <30 <30

3 Minutes Step Test

RATING CHART: BALANCE, COORDINATION,
Resting HeartRate AND REACTION TIME
Performance Rating Stick Balance Wand Juggling Meter Stick Drop
High Performance 20 9 to 10 Less than 14 inches
Working HeartRate Good Fitness 16 to 18 7 to 8 14 to 18 inches
Marginal Performance 7 to 15 4 to 6 19 to 21 inches
More than 21
Recovery Heart Low Fitness Less than 6 Less than 4
Rate inches

COMPONENT BEING PERFORMANCE

BATTERY TEST TESTED RATING/RESULT INDICATOR
Cardio Respiratory
3 – minute Step Test Endurance
Strength of the
Bent Knee Curl Ups
Abdominal Muscle
Arm Push-ups/Knee
push ups Arm
Strength
Core
Basic Plank muscle
strength,
Sit and Reach Flexibility
Hexagon Agility Test Agility
Trunk Lift Flexibility
Stork Balance Balance
Standing long Jump Leg Power
Paper Toss Coordination
Stick Drop Reaction
Time 50 meter sprint Speed

 3 – Minute step Test: Rating - How many steps? PI: Completed/Incomplete;

 Bent Knee Curl Ups: Rating – How many correct/proper Curl Ups? / PI – Completed/Incomplete
 Arm Push Ups/Knee Push Ups: Rating – How many correct/proper executions? PI – Completed/Incomplete
 Sit and Reach: Rating - How many correct/proper executions? / PI – Completed/Incomplete
 Basic Plank : how long can student hold their plank ( 59 sec. incomplete 1min. above complete)
 Stork Balance : Rating – Points for 10 seconds ( 1 pt. if you balanced for 10 sec successfully/try the stunt
twice) PI - refer to Rating Chart above; Paper toss : Rating: Total toss points (left and right) PI – refer to Rating
Chart;
 Standing Long Jump : Rating – Score in meters/cm PI – Completed/Incomplete;
 Stick Drop : Rating – The score/number on the ruler at the place where you caught it/ PI – Refer to Rating
chart above;
 50 m Sprint: Rating – Record of time in minutes or seconds/ PI – Completed/Incomplete

CHECKED AND EVALUATED BY: Mr. Mark Lorenz B. Darilag , Mr. Tachie Solaña & Mr. Jeremy Surban

Date: Evaluation Grade: