"Fitness Assessment Form"

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Fitness Assessment Form
Name (last, first) ______________________________
Assessment Date ___/___/______
Birth date ___/___/_____
Age: ____
Resting Blood Pressure _____/_____
Resting HR ____
Weight ______lb _____kg
Height ______in.
Sex M / F
Body Composition
% Body Fat:
% Lean Mass:
Bioelectrical Impedance Reading:
_______% Body Fat
_______ BMI
Girth Measurements:
Chest:
_____ in
Calf:
_____/ _____ in (Right/Left)
Waist:
_____ in
Ankle:
_____/ _____ in (Right/Left)
Hips:
_____ in
Upper Arm:
_____/ _____ in (Right/Left)
Thigh:
_____/ _____ in (Right/Left)
Wrist:
_____/ _____ in (Right/Left)
Cardiovascular Fitness
Predicted VO
max:
mL/kg/min
2
Rockport Fitness Walking Test (1-mile walk)
BYU Jog Test (1-mile)
Begin with light warm up by walking and light
Begin with a 2-3 minute jog to warm up
stretching
Time
Heart Rate
Time
Heart Rate
Lap 1:
_____
_____ bpm
Lap 1:
_____
_____ bpm
Lap 2:
_____
_____ bpm
Lap 2:
_____
_____ bpm
Lap 3:
_____
_____ bpm
Lap 3:
_____
_____ bpm
Lap 4:
_____
_____ bpm
Lap 4:
_____
_____ bpm
Lap 5:
_____
_____ bpm
Lap 5:
_____
_____ bpm
Lap 6:
_____
_____ bpm
Lap 6:
_____
_____ bpm
Lap 7:
_____
_____ bpm
Lap 7:
_____
_____ bpm
Fitness Assessment Form
Name (last, first) ______________________________
Assessment Date ___/___/______
Birth date ___/___/_____
Age: ____
Resting Blood Pressure _____/_____
Resting HR ____
Weight ______lb _____kg
Height ______in.
Sex M / F
Body Composition
% Body Fat:
% Lean Mass:
Bioelectrical Impedance Reading:
_______% Body Fat
_______ BMI
Girth Measurements:
Chest:
_____ in
Calf:
_____/ _____ in (Right/Left)
Waist:
_____ in
Ankle:
_____/ _____ in (Right/Left)
Hips:
_____ in
Upper Arm:
_____/ _____ in (Right/Left)
Thigh:
_____/ _____ in (Right/Left)
Wrist:
_____/ _____ in (Right/Left)
Cardiovascular Fitness
Predicted VO
max:
mL/kg/min
2
Rockport Fitness Walking Test (1-mile walk)
BYU Jog Test (1-mile)
Begin with light warm up by walking and light
Begin with a 2-3 minute jog to warm up
stretching
Time
Heart Rate
Time
Heart Rate
Lap 1:
_____
_____ bpm
Lap 1:
_____
_____ bpm
Lap 2:
_____
_____ bpm
Lap 2:
_____
_____ bpm
Lap 3:
_____
_____ bpm
Lap 3:
_____
_____ bpm
Lap 4:
_____
_____ bpm
Lap 4:
_____
_____ bpm
Lap 5:
_____
_____ bpm
Lap 5:
_____
_____ bpm
Lap 6:
_____
_____ bpm
Lap 6:
_____
_____ bpm
Lap 7:
_____
_____ bpm
Lap 7:
_____
_____ bpm
Fitness Assessment Form
3 Minute YMCA Step Test (Beginner)
McArdle Step Test (Advanced)
Begin with light warm up by walking and
Begin with light warm up by walking
light stretching
and light stretching
Cadence: 96 bpm
Cadence: Men:
96 bpm
Women: 88 bpm
Heart Rate: ___________ bpm
Heart Rate: ___________ bpm
Muscular Endurance
Push-ups / min: _______
Percentile (rank): _____________________
YMCA Bench Press Test: ______ reps
Percentile (rank): _____________________
Sit-ups / min: _______
Percentile (rank): _____________________
Flexibility
Sit and Reach: 1.) _________
2.)_________
3.)_________
Comments/Calculations:
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