Form CJSTC75B "Physical Fitness Assessment" - Florida

What Is Form CJSTC75B?

This is a legal form that was released by the Florida Department of Law Enforcement - a government authority operating within Florida. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on June 1, 2008;
  • The latest edition provided by the Florida Department of Law Enforcement;
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  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form CJSTC75B by clicking the link below or browse more documents and templates provided by the Florida Department of Law Enforcement.

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Download Form CJSTC75B "Physical Fitness Assessment" - Florida

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CJSTC
PHYSICAL FITNESS ASSESSMENT
75B
Florida Department of
Law Enforcement
Incorporated by Reference in Rule 11B-35.001(11)(c)12., F.A.C.
1.
Applicant’s Name:
Last
First
MI
2.
Applicant’s Address:
3.
Enter Last Four Digits of Social Security Number:
4.
Training School:
5.
The Applicant Is Requesting Admission Into a Basic Recruit Training Program for One of the Following Disciplines:
Law Enforcement
Correctional
Correctional Probation
6.
Student Participation in Basic Recruit Training Program Activities. A student enrolled in a basic recruit training program (BRTP) is required to participate in the
following activities:
A.
Defensive tactics and firearms high-liability training, which is a component of the curriculum mandated by the Criminal Justice Standards and Training
Commission. Firearms training requires firing a handgun and long gun creating exposure to lead. Defensive tactics training requires sustained physical exertion
and chemical agent contamination to the chemicals oleo-resin capsicum (OC) and/or orthochlorobenzal-malonotrite (CS).
B.
Physical Fitness Conditioning and Physical Fitness Testing: A BRTP student shall participate in physical fitness conditioning and a fitness test and includes
the following measures:
• Vertical Jump
• One Minute Sit Ups
• 300 Meter Run
• Maximum Push Ups
• 1.5 Mile Run/Walk
C.
The training center director has attached the training schools physical fitness conditioning program: Yes
**********TO BE COMPLETED BY THE APPLICANT*********
7.
Medical Conditions Regarding OC/CS Contamination. A BRTP student should be aware of the following personal considerations that may restrict participation in
the chemical agent contamination of the BRTP and could possibly be aggravated to a severe degree during the contamination: Recent eye surgery, heart problems,
panic disorder or stress, respiratory disorder, emphysema (loss of elasticity/thinning of lung tissues), bronchial asthma, x-ray evidence of pneumoconiosis (black lung),
evidence of reduced pulmonary (lung) function, chronic obstructive pulmonary disease, coronary (heart) artery disease, cerebral (brain) blood vessel disease, severe or
progressive hypertension (high blood pressure), epilepsy, grand mal or petite mal (seizures), pernicious anemia (severe reduction in red blood cells), diabetes (any
form), pueumomediastinum gap (air in the sac surrounding lungs), history of skin allergies, or any condition for which the student is presently taking medication.
8.
BRTP Student Certification. I certify that I have reviewed the above information and
I do or
do not have any medical restrictions that would prevent me from
participating in the basic recruit training program activities outlined in item numbers 6, 6A, and 6B above.
9.
Student’s Printed Name: ___________________________________
10.
Student’s Signature:_____________________________________
Date:
11.
Prior Exposure to OC or CS. For a student who has had prior chemical agent exposure that includes chemical agent contamination and working through the effects
of chemical agent contamination in a training environment, please attach the supporting documentation of prior exposure and check one of the following boxes:
I certify that I have
OR I have not
been exposed to oleo-resin capsicum (OC) and/or orthochlorobenzal-malononitrile (CS) in the manner described in
item number 11.
**********TO BE COMPLETED BY THE EXAMINING PHYSICIAN*********
12.
Physician Attestment. The above applicant is seeking entry into a law enforcement, correctional, or correctional probation basic recruit training program. Rule 11B-
35.001(11)(c)12., F.A.C., requires a complete physical examination at a level of specificity sufficient to determine whether there are any medical or physiological
restrictions that would prevent the applicant from performing the required activities described in items 6, 6A, and 6B above. Disabilities, impairment, or limitations
identified by the examination that would prevent the applicant from performing the required activities should be reported to the training school indicated in item number
4 above.
I hereby attest that I have examined the above named applicant and find him or her CAPABLE of participating in the basic recruit training program activities
indicated in item numbers 6, 6A, and 6B above.
I hereby attest that I have examined the above named applicant and find him or her NOT CAPABLE of participating in the basic recruit training program activities
indicated in item numbers 6, 6A, and 6B above
13.
Physician, Certified Advanced Registered
Printed Name
Examination Date
Nurse Practitioner, or Physician Assistant’s Signature
14.
Physician, Certified Advanced Registered Nurse Practitioner, or Physician Assistant’s License Number
Licensing State
15.
Physician, Certified Advanced Registered Nurse Practitioner, or Physician Assistant’s Professional Address
**********TO BE COMPLETED BY THE TRAINING CENTER DIRECTOR OR DESIGNEE*********
16.
Training Center Director or Designee’s Printed Name:
Training Center Director or Designee’s Signature:
Date:
Training School: Original
Agency: Copy
Applicant: Copy 1 of 2
Proposed Effective Date June 2008
CJSTC
PHYSICAL FITNESS ASSESSMENT
75B
Florida Department of
Law Enforcement
Incorporated by Reference in Rule 11B-35.001(11)(c)12., F.A.C.
1.
Applicant’s Name:
Last
First
MI
2.
Applicant’s Address:
3.
Enter Last Four Digits of Social Security Number:
4.
Training School:
5.
The Applicant Is Requesting Admission Into a Basic Recruit Training Program for One of the Following Disciplines:
Law Enforcement
Correctional
Correctional Probation
6.
Student Participation in Basic Recruit Training Program Activities. A student enrolled in a basic recruit training program (BRTP) is required to participate in the
following activities:
A.
Defensive tactics and firearms high-liability training, which is a component of the curriculum mandated by the Criminal Justice Standards and Training
Commission. Firearms training requires firing a handgun and long gun creating exposure to lead. Defensive tactics training requires sustained physical exertion
and chemical agent contamination to the chemicals oleo-resin capsicum (OC) and/or orthochlorobenzal-malonotrite (CS).
B.
Physical Fitness Conditioning and Physical Fitness Testing: A BRTP student shall participate in physical fitness conditioning and a fitness test and includes
the following measures:
• Vertical Jump
• One Minute Sit Ups
• 300 Meter Run
• Maximum Push Ups
• 1.5 Mile Run/Walk
C.
The training center director has attached the training schools physical fitness conditioning program: Yes
**********TO BE COMPLETED BY THE APPLICANT*********
7.
Medical Conditions Regarding OC/CS Contamination. A BRTP student should be aware of the following personal considerations that may restrict participation in
the chemical agent contamination of the BRTP and could possibly be aggravated to a severe degree during the contamination: Recent eye surgery, heart problems,
panic disorder or stress, respiratory disorder, emphysema (loss of elasticity/thinning of lung tissues), bronchial asthma, x-ray evidence of pneumoconiosis (black lung),
evidence of reduced pulmonary (lung) function, chronic obstructive pulmonary disease, coronary (heart) artery disease, cerebral (brain) blood vessel disease, severe or
progressive hypertension (high blood pressure), epilepsy, grand mal or petite mal (seizures), pernicious anemia (severe reduction in red blood cells), diabetes (any
form), pueumomediastinum gap (air in the sac surrounding lungs), history of skin allergies, or any condition for which the student is presently taking medication.
8.
BRTP Student Certification. I certify that I have reviewed the above information and
I do or
do not have any medical restrictions that would prevent me from
participating in the basic recruit training program activities outlined in item numbers 6, 6A, and 6B above.
9.
Student’s Printed Name: ___________________________________
10.
Student’s Signature:_____________________________________
Date:
11.
Prior Exposure to OC or CS. For a student who has had prior chemical agent exposure that includes chemical agent contamination and working through the effects
of chemical agent contamination in a training environment, please attach the supporting documentation of prior exposure and check one of the following boxes:
I certify that I have
OR I have not
been exposed to oleo-resin capsicum (OC) and/or orthochlorobenzal-malononitrile (CS) in the manner described in
item number 11.
**********TO BE COMPLETED BY THE EXAMINING PHYSICIAN*********
12.
Physician Attestment. The above applicant is seeking entry into a law enforcement, correctional, or correctional probation basic recruit training program. Rule 11B-
35.001(11)(c)12., F.A.C., requires a complete physical examination at a level of specificity sufficient to determine whether there are any medical or physiological
restrictions that would prevent the applicant from performing the required activities described in items 6, 6A, and 6B above. Disabilities, impairment, or limitations
identified by the examination that would prevent the applicant from performing the required activities should be reported to the training school indicated in item number
4 above.
I hereby attest that I have examined the above named applicant and find him or her CAPABLE of participating in the basic recruit training program activities
indicated in item numbers 6, 6A, and 6B above.
I hereby attest that I have examined the above named applicant and find him or her NOT CAPABLE of participating in the basic recruit training program activities
indicated in item numbers 6, 6A, and 6B above
13.
Physician, Certified Advanced Registered
Printed Name
Examination Date
Nurse Practitioner, or Physician Assistant’s Signature
14.
Physician, Certified Advanced Registered Nurse Practitioner, or Physician Assistant’s License Number
Licensing State
15.
Physician, Certified Advanced Registered Nurse Practitioner, or Physician Assistant’s Professional Address
**********TO BE COMPLETED BY THE TRAINING CENTER DIRECTOR OR DESIGNEE*********
16.
Training Center Director or Designee’s Printed Name:
Training Center Director or Designee’s Signature:
Date:
Training School: Original
Agency: Copy
Applicant: Copy 1 of 2
Proposed Effective Date June 2008
INSTRUCTIONS FOR COMPLETING FORM CJSTC-75B
An applicant approved to enter a basic recruit training program (BRTP) shall review and complete form CJSTC-75B to indicate the presence of any medical conditions that may
prevent participation in the Physical Fitness Program and Chemical Agent Contamination. A copy of the Physical Fitness Program for law enforcement, correctional, or correctional
probation discipline shall be attached to this form for the applicant to review.
1.
Applicant’s Name. Enter the applicant’s last name, first name, and middle initial.
2.
Applicant’s Address. Enter the applicant’s current address, city, state, and zip code.
3.
Applicant’s Social Security Number. Enter the last four digits of the applicant’s social security number as in this example: 000-00-1234.
4.
Training School Name. Enter the name of the Commission-certified criminal justice training school where the applicant is enrolled.
5.
Basic Recruit Training Program Discipline. Place a check mark in one of the box(es) for the law enforcement, correctional, or correctional probation basic recruit training
program discipline for which the applicant is requesting admission.
6.
Student Participation in Basic Recruit Training Program Activities. Defensive Tactics (includes chemical agent contamination), Firearms, and Physical Fitness
Conditioning and Physical Fitness Testing: High-liability training in defensive tactics, firearms, and chemical agent contamination is a component of the curriculum
mandated by the Criminal Justice Standards and Training Commission and participation in the activities is a requirement for successfully completing a BRTP. There is no
pass or fail at this time. The test results for each of the five required tests will be recorded on the Academy Physical Fitness Standards Report, form CJSTC-67A as “I” if
the student did not perform the test component or “D” if the student was dismissed from the basic recruit training program.
A.
Defensive Tactics and Firearms Training. Firearms training requires firing a handgun and long gun creating exposure to lead. Defensive tactics training requires
sustained physical exertion and chemical agent contamination to the chemicals oleo-resin capsicum (OC) and/or orthochlorobenzal-malonotrite (CS).
B.
Physical Fitness Conditioning and Physical Fitness Testing. The Physical Fitness Test includes the following measures and are defined as follows:
Vertical Jump. This measures leg power by measuring how high a person jumps.
One Minute Sit Ups. This measures abdominal, or trunk, muscular endurance. While lying on his/her back, the student will be given one minute to do as many
bent-leg sit ups as possible.
300 Meter Run. This measures anaerobic power, or the ability to make an intense burst of effort for a short time period or distance. This component consists of
sprinting 300 meters as fast as possible.
Maximum Push Ups. This measures the muscular endurance of the upper body. This component consists of doing as many push ups as possible until
muscular failure. Males are required to perform the standard push-up and females have the option to perform the standard or modified push-up.
1.5 Mile Run/Walk. This measures aerobic power or cardiovascular endurance (stamina over time). To complete this component, the student runs or walks a
distance of 1.5 miles as fast as possible.
C.
A physical fitness conditioning program developed by the training school shall be attached to form CJSTC-75B prior to the student’s examination by a
physician, certified advanced registered nurse practitioner, or the physician’s assistant.
7.
Medical Conditions Regarding Chemical Agent Contamination. The student shall review the listed medical conditions and list other conditions that may restrict him or
her from participating in Chemical Agent Contamination to the chemicals oleo-resin capsicum (OC) and/or orthochlorobenzal-malonotrite (CS).
8.
Basic Recruit Training Program Activities Certification. The student shall check the appropriate box to indicate if he or she does or does not have a medical condition
that would restrict participation in the basic recruit training program activities indicated in item numbers 6, 6A, and 6B of this form.
9.
Student’s Printed Name. The student shall print his or her first name, last name, and middle initial.
10.
Student’s Signature and Date. The student shall provide a signature and date to verify the information provided by the student is true and correct.
11.
Prior Exposure to Chemical Agent Contamination. The student shall Indicate in the appropriate box if he or she has been previously exposed to chemical agent
contamination to the chemicals oleo-resin capsicum (OC) and/or orthochlorobenzal-malonotrite (CS), and shall attach supporting documentation of such contamination.
12.
Physician, Certified Advanced Registered Nurse Practitioner, or Physician Assistant’s Attestment. The physician shall check the appropriate box to indicate if the
student is capable or not capable of participating in the basic recruit training program activities indicated in item numbers 6, 6A, and 6B of this form.
13.
Physician, Certified Advanced Registered Nurse Practitioner, or Physician Assistant’s Signature, Printed Name, and Examination Date. The physician shall
complete this item to verify his or her attestment to item number 12 of this form.
14.
Physician, Certified Advanced Registered Nurse Practitioner, or Physician Assistant’s License Number and Licensing State. The physician shall complete this item
to verify his or her valid license number and licensing state.
15.
Physician, Certified Advanced Registered Nurse Practitioner, or Physician Assistant’s Professional Address. The physician shall print his or her complete
professional address.
16.
Training Center Director/Designee’s Printed Name, Signature and Date. The training center director/designee who signs this form shall print his or her legal first and last
name. The training center director/designee shall sign and date this form.
FORM CJSTC-75B
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Physical fitness is most easily understood by examining its components, or "parts."
There is widespread agreement that these four components are basic.
1.
Cardiorespiratory Endurance – the ability to deliver oxygen and nutrients to
tissues, and to remove wastes, over sustained periods of time.
Long runs
and
swims
are among the methods employed in measuring this component.
2.
Muscular Strength – the ability of a muscle to exert force for a brief period of
time. Upper-body strength, for example, can be measured by various
weight-lifting
exercises.
3.
Muscular Endurance – the ability of a muscle, or a group of muscles, to sustain
repeated contractions or to continue applying force against a fixed object.
Pushups
are
often used to test endurance of arm and shoulder muscles.
4.
Flexibility – the ability to move joints and use muscles through their full range of
motion. The
sit-and-reach test
is a good measure of flexibility of the lower back and
backs of the upper legs.
THE WORKOUT SCHEDULE
The physical fitness training plan will include something from each of the four basic
fitness components described above. Each workout will begin with a warm-up and end
with a cool down. As a general rule, the workouts will be spaced throughout the week
and avoid consecutive days of hard exercise. Approximately three (3) hours each
week, throughout the duration of the basic academy,
will be dedicated to physical fitness training.
Here are the amounts of activity necessary for the average,
healthy academy cadet to maintain and/or increase his or
her overall level of fitness. Included are some of the
popular exercises we will be using in each category.
WARMUP – five to ten minutes of exercises such as walking,
slow
jogging,
knee
lifts,
arm circles
or
trunk
rotations. Low intensity movements that stimulate movements to
be used in the activity can also be included in the warm-up.
MUSCULAR STRENGTH – approximately two 20 minute sessions
per week that include exercises for all the major muscle groups.
Lifting weights
is the most effective way to increase strength. The
use of fitness cords and bands can be used to reduce the risk of
injury and to keep equipment costs at a minimum.
BRTP - Physical Fitness Training Plan – Page 1 of 2
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MUSCULAR ENDURANCE – approximately three 30 minute
sessions each week that include exercises such as calisthenics,
pushups, sit-ups, pull-ups, and
weight training
for all the major
muscle groups. The use of fitness cords and bands can be used
to reduce the risk of injury and to keep equipment costs at a
minimum.
CARDIORESPIRATORY ENDURANCE – approximately three 20 minute bouts of
continuous aerobic (activity requiring oxygen) rhythmic exercise each week. Popular
aerobic conditioning activities include
brisk
walking, jogging, swimming, cycling,
rope-jumping, rowing, cross-country skiing, and some continuous action games like
racquetball
and handball.
FLEXIBILITY – ten to twelve minutes of stretching exercises
performed slowly without a bouncing motion. This can be included
after a warm-up or during a cool down.
COOL DOWN – approximately five to ten minutes of slow walking,
low-level exercise, combined with stretching.
Sample One (1) Hour Workout:
1. Warm Ups:
Trunk
Rotations,
Arm
Circles, Lunges,
Stretching
10 Minutes
2. Muscular Endurance:
Push
Ups,
Sit
Ups,
Pull Ups
10 Minutes
3. Cardiorespiratory Endurance:
30 Minute
Class Run
30 Minutes
4. Flexibility/Cool Down:
Slow
Walk,
Stretching
10 Minutes
Pace will vary based on fitness level of group running; classes can be broken into different
groups based on individual fitness level (i.e., beginning, advanced, etc…).
Supplemental handouts for the Physical Fitness Training Plan are attached and listed
below:
PF Training Plan Handout #1: Warm Up & Stretching
PF Training Plan Handout #2: The Importance of Hydration during Exercise
PF Training Plan Handout #3: Beating the Heat during Summer Exercise
PF Training Plan Handout #4: Common Forms of Heat Related Illnesses
PF Training Plan Handout #5: Jogging Safely
PF Training Plan Handout #6: 10 Basic Weight Training Exercises
Additional PF Training Plan Handouts are in development.
Note: This two page outline of the Physical Fitness Training Plan should be attached to the CJSTC Form
#75B – Basic Recruit Student Physical Fitness and Chemical Agent Contamination to be viewed by the
examining physician.
BRTP - Physical Fitness Training Plan – Page 2 of 2
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