"Fitness Assessment Form - Powerhouse Gym"

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FITNESS ASSESSMENT FORM
              NAME:______________________________________MEMBERSHIP NO.________________ 
              TRAINER:______________________________________________________________________ 
              BIRTH DATE:___________________________________________________________________ 
              MALE:_______________________________  FEMALE:____________________________________ 
              HEIGHT:________________________________________________________________________ 
 
 
CURRENT WEIGHT: 
       __   
CLASSIFICATION:  
____________ 
HEALTHY WEIGHT:________________ 
CURRENT BMI:                          __   
CLASSIFICATION:                 ____________  
HEALTHY BMI:_________________ 
 
 
BODY FAT % ASSESSMENT 
MEN/WOMEN 
SKIN FOLD SITE
MEASUREMENT (mm)
CHEST
MIDAXILLARY
TRICEP
SUBSCAPULAR
ABDOMEN
SUPRAILIAC
THIGH
            
               BODY FAT %:_________ OPTIMAL BODY FAT %_________ 
Men
7 Site Formula (chest, midaxillary, triceps, subscapular, abdomen, suprailiac, thigh)
Body Density (BD)= 1.112 - 0.00043499 x (Sum of 7Skinfolds) + 0.00000055 x ( Sum of 7 Skinfolds)^2 – 0.00028826
Body Density (BD)= 1.112 - 0.00043499 x (________)+ 0.00000055 x (_______)^2 – 0.00028826 x _____
Women
Body Density = 1.097 - 0.00046971 x (Sum of 7Skinfolds) + 0.00000056 x ( Sum of 7 Skinfolds)^2 – 0.0002826 x age)
Body 7 Site Formula (chest, midaxillary, triceps, subscapular, abdomen, suprailiac, thigh)
Density = 1.097 - 0.00046971 x _____ + 0.00000056 x (_____)^2 – 0.0002826 x _____
FITNESS ASSESSMENT FORM
              NAME:______________________________________MEMBERSHIP NO.________________ 
              TRAINER:______________________________________________________________________ 
              BIRTH DATE:___________________________________________________________________ 
              MALE:_______________________________  FEMALE:____________________________________ 
              HEIGHT:________________________________________________________________________ 
 
 
CURRENT WEIGHT: 
       __   
CLASSIFICATION:  
____________ 
HEALTHY WEIGHT:________________ 
CURRENT BMI:                          __   
CLASSIFICATION:                 ____________  
HEALTHY BMI:_________________ 
 
 
BODY FAT % ASSESSMENT 
MEN/WOMEN 
SKIN FOLD SITE
MEASUREMENT (mm)
CHEST
MIDAXILLARY
TRICEP
SUBSCAPULAR
ABDOMEN
SUPRAILIAC
THIGH
            
               BODY FAT %:_________ OPTIMAL BODY FAT %_________ 
Men
7 Site Formula (chest, midaxillary, triceps, subscapular, abdomen, suprailiac, thigh)
Body Density (BD)= 1.112 - 0.00043499 x (Sum of 7Skinfolds) + 0.00000055 x ( Sum of 7 Skinfolds)^2 – 0.00028826
Body Density (BD)= 1.112 - 0.00043499 x (________)+ 0.00000055 x (_______)^2 – 0.00028826 x _____
Women
Body Density = 1.097 - 0.00046971 x (Sum of 7Skinfolds) + 0.00000056 x ( Sum of 7 Skinfolds)^2 – 0.0002826 x age)
Body 7 Site Formula (chest, midaxillary, triceps, subscapular, abdomen, suprailiac, thigh)
Density = 1.097 - 0.00046971 x _____ + 0.00000056 x (_____)^2 – 0.0002826 x _____
 
MUSCULAR STRENGTH TESTING 
UPPER BODY STRENGTH ASSESSMENT 
BENCH PRESS TEST 
40%‐60% of Perceived Maximum:______lbs. (5‐10 reps) 
60%‐80% of Perceived Maximum:______lbs. (3‐5 reps) 
1‐RM:_____lbs.           Classification:______________ 
 
LOWER BODY STRENGTH ASSESSMENT 
LEG PRESS TEST 
40%‐60% of Perceived Maximum:______lbs. (5‐10 reps) 
60%‐80% of Perceived Maximum:______lbs. (3‐5 reps) 
1‐RM:_____lbs.           Classification:______________ 
 
 
MUSCULAR ENDURANCE TESTING 
UPPER BODY ENDURANCE ASSESSMENT 
PUSH‐UP TEST 
Maximal number of Push‐Ups performed consecutively without rest:_____________ 
Classification:_____________ 
CORE ENDURANCE ASSESSMENT 
ABDOMINAL CRUNCH TEST 
Maximal number of Crunches performed consecutively without rest:_____________ 
Classification:_____________
 
 
 
FLEXIBILITY TESTING 
HAMSTRING, HIP, AND LOWER BACK FLEXIBILITY ASSESSMENT 
 
SIT‐AND‐REACH TEST 
Trial 1:_________ Trial 2:_________ Trial 3:_________  
 
Best Trial:__________    Classification:______________
 
CARDIOVASCULAR ASSESSMENT 
 
Resting HR:_______BPM 
Resting BP:_______mmHg 
 
ACSM CARDIORESPIRATORY CLASSIFICATION 
 
Light Exercise: 35%‐54%:_________ 
Moderate Exercise: 55%‐69%:_________ 
Hard Exercise: 70%‐89%:_________ 
 
220 – age = Max predicted HR 
MPHR x % = Intensity level 
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