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Republic of the Philippines

Department of the Interior and Local Government


BUREAU OF FIRE PROTECTION
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PHYSICAL FITNESS TEST FORM

*Name: ____________________________________________ Date: _____________


Rank Surname First Name M.I.

*Address: _____________________________________________________________
*Unit/Office Assignment: ________________________________*Age: ____*Sex: ____
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*Height: __________*Weight: __________*BP: _____________*PR (bpm): _________
*BMI: __________ GO/No-Go: ___________ Remarks: _________________________

*_____________________ _____________________
Signature of Examinee Medical Officer

DO NOT FILL UP BELOW.

EVENT SCORE/TIME POINTS REMARKS


Push-ups (1 min.)
Sit-ups (1 min.)
Endurance Run
21-29 (3 km.)
30-39 (2 km.)
40 – above (1 km.)

Hose Carry (50 meters)


Female (1 ½ hose)
Male
21-39 (2 ½ hose)
40 – above (1 ½ hose)

Total >>>

FINAL RESULT (Pass/Fail): _________________

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Tactical Officer

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