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 : ___________________________________ AGE/SEX : ______________________

SCHOOL : ___________________________________ DISTRICT : ______________________

Part I : HEALTH RELATED FITNESS TEST

A. BODY COMPOSITION
1. BODY MASS INDEX ( BMI ) 2. WAIST CIRCUMFERENCE
Grade Level Waist Circumference Interpretation Grade Height (in Weight (in BMI Classification
(in centimeters) Level inches) kgs)

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

HEART RATE PER MINUTE 1. 90 DEGREES PUSH-UP 2. CURL-UP

Grade level Resting Heart Rate Training Heart Rate Grade Level Number of Push- Up Number of Curl- Up

D. FLEXIBILITY

1.ZIPPER TEST 2. SIT AND REACH

Grade level Overlap (cm ) Score Grade Level Score ( cm )

Part II SKILL- RELATED TEST

A. SPEED : 40 meter sprint
Grade Level Time ( 00.00 )
B. POWER
1. Basketball Pass 2. Standing Long Jump

Distance ( Meter ) Grade Level Distance ( cm )

st nd rd
Grade Level 1 Trial 2 Trial 3 Trial

C. AGILITY : Hexagon Agility Test

Grade Level Clockwise ( Time ) Counterclockwise ( Time ) Average ( Time )

D. REACTION TIME : Stick Drop Test

st nd rd
Grade Level 1 Trial 2 Trial 3 Trial Middle Score

E. COORDINATION : Paper Juggling

st nd
Grade Level 1 Trial 2 Trial
Number of Hits Number of Hits

F. BALANCE : Stork Balance Stand Test

st nd
1 Trial Time (secs) 2 Trial Time (secs )
Grade Level Left Right Left Right

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Name & Signature of Pupil