Republic of the Philippines

DEPARTMENT OF EDUCATION
Region IV-A CALABARZON
Division of Laguna
District of Alaminos

SAN ANDRES ELEMENTARY SCHOOL

PHYSICAL FITNESS TEST FORM
NAME: 1. ALICANDO, JAN KHAYLEM ATAG AGE/SEX: 9 years, 5 months
/ Male

SCHOOL: SAN ANDRES ELEMENTARY SCHOOL DISTRICT : ALAMINOS

Part I : HEALTH RELATED FITNESS TEST

A. BODY COMPOSITION
1. BODY MASS INDEX (BMI) 2. WAIST CIRCUMFERENCE
Grade Waist Interpretation
Level Circumference (in Grade Height Weight (in BMI Classificatio
centimeters) Level (in kgs) n
One inches)
One
Two
Two
Three
Three
Four
Four
Five
Five
Six
Six

B. CARDIOVASCULAR ENDURANCE : 3- Minute Step C. MUSCULAR STRENGHT

HEART RATE PER MINUTE

1. 90 DEGREES PUSH-UP 2. CURL-UP
Grade Resting Heart Training Heart
level Grade Level Number of Push- Up Number of Curl- Up
Rate Rate
One One
Two Two
Three Three
Four Four
Five Five
Six Six

D. FLEXIBILITY

1.ZIPPER TEST 2. SIT AND REACH

Grade Overlap (cm ) Score Grade Level Score ( cm )
level
One One
Two Two
Three Three
Four
Four
Five Five
Six
Six

Part II SKILL- RELATED TEST

A. SPEED : 40 meter sprint
Grade Level Time ( 00.00 )
One
Two
Three
Four
Five
Six
B. POWER
1. Basketball Pass 2. Standing Long Jump

Distance ( Meter ) Grade Level Distance ( cm )

Grade Level st
1 Trial 2nd 3rd One
Trial Trial
Two
One
Two Three
Three Four
Four Five
Five Six
Six
C. AGILITY : Hexagon Agility Test

Grade Level Clockwise ( Time ) Counterclockwise Average ( Time )

( Time )
One One
Two Two
Three Three
Four Four
Five Five
Six Six

D. REACTION TIME : Stick Drop Test

Grade Level 1st Trial 2nd Trial 3rd Trial Middle Score
One
Two
Three
Four
Five
Six

E. COORDINATION : Paper Juggling

Grade Level 1st Trial 2nd Trial

One Number of Hits Number of Hits
Two
Three
Four
Five
Six

F. BALANCE : Stork Balance Stand Test

1st Trial Time (secs) 2nd Trial Time (secs )

Grade Level Left Right Left Right
One
Two
Three
Four
Five
Six

ALICANDO, JAN KHAYLEM ATAG

Name & Signature of Pupil