Form A

Department of Education
Region X-Northern Mindanao
DIVISION OF MALAYBALAY CITY
Purok 6, Casisang, Malaybalay City
_______________________________________________________________________________

PHYSICAL FITNESS TEST (PFT) SCORE CARD

S.Y. 2016 - 2017

NAME: ___________________________________ GRADE/SECTION: __________________AGE: _____

SEX: ____
SCHOOL: _________________________________ DISTRICT: ______________ BIRTHDAY:
__________________

PART I. HEALTH – RELATED FITNESS TEST

PARAMETERS ACTIVITIES PRE-TEST POST-

(1 st TEST
Quarter) (4 th
Quarter)
Body Mass Index  Height (meters)
A. BODY (BMI)  Weight (kilograms)
COMPOSITION  BMI
BMI = Weight (kg.)  Classification
Height (m) 2
Heart Rate Per Minute
B. CARDIOVASCULA 3 – Minute Step Test  Before the Activity
R Heart Rate Per Minute
ENDURANCE  After the Activity
Heart Rate Recovery
C. STRENGTH 90 Degrees Push-Up  Number of Push-Up
Basic Plank  Time (00:00)
Zipper Test Overlap Gap – Right Arm (cm)
D. FLEXIBILITY Overlap Gap – Left Arm (cm)
 First Try
Sit and Reach (cm)  Second Try
 Best Score

PART II. SKILL – RELATED FITNESS TEST

PARAMETERS ACTIVITIES PRE- POST-

TEST TEST
A. COORDINATION Juggling  Score: Number of Hits
 Clockwise Time (00:00)
B. AGILITY Hexagon Agility Test  Counter Clockwise Time
C. SPEED 40 Meter Sprint  Time (00:00)
 First Trial (cm)
D. POWER Standing Long Jump  Second Trial (cm)
(distance in cm)  Middle Score (cm)
Stork Balance Stand  Right Foot Time (00:00)
E. BALANCE Test  Left Foot Time (00:00)
 First Trial (cm)
F. REACTION TIME Stick Drop Test  Second Trial (cm)
 Third Trial (cm)
  Middle Score (cm)

______________________________________ __________________________________
Name of MAPEH Teacher Name of MAPEH Dept. Head