"Army Semi-annual Weigh-In Record Form"

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Record of Semi-Annual Weigh-In
DATE: _______________
EMPLID: ______________ NAME: ______________________________________________ AGE: _________
BLOCK 1: All members, initial screening, no shoes
HEIGHT
WEIGHT
Height
inches
58
131
Round up to nearest whole number
59
136
MAX Allowable weight per BMI table
pounds
60
141
61
145
Weight
62
150
Round down to nearest whole number
pounds
63
155
64
160
ODU w/ blouse – subtract 4.0 lbs.
65
165
Tropical Blue or organizational clothing– subtract 3 lbs.
66
170
T-shirt and trousers or sweatpants - subtract 2 lbs.
67
175
T-shirt and gym shorts - subtract 1 lb.
68
180
69
186
BLOCK 2: Body fat determination (if needed)
70
191
MAXIMUM BODY FAT
Enter MAX body fat
71
197
AGE
MEN
WOMEN
72
202
LESS THAN
73
208
22%
32%
%
30
74
214
LESS THAN
75
220
24%
34%
40
76
225
40 and above
26%
36%
77
231
inches
78
237
Enter Circumference Value as determined below
79
244
Enter Body fat from CIM 1020.8H enclosure (2)
%
80
250
Compliant? Y ___ N ___
Circumference Value determination:
Waist
+ Buttocks
- Neck
= Total
(females only, use 0
Round down to nearest half-inch.
for males) Round down to nearest
Round up to nearest half-
Measure over the bellybutton for
half-inch. Measure the widest point
inch, measure below
males, smallest point for females.
when viewed from side.
larynx
Set 1
+
-
=
Set 2
+
-
=
Set 3
+
-
=
Compare the three totals. Is any difference greater than 1.0?
Set 1 total _________ - Set 2 total __________ = ________
Set 2 total _________ - Set 3 total __________ = ________
Are any of these differences greater than 1.0?
Set 3 total _________ - Set 1 total __________ = ________
No.
All totals are within 1.0 inches of each other. Enter lowest total of the three sets as the Circumference
Value for block 2.
Yes.
Complete an additional set of measurements and then calculate an average circumference value using
only the three closest set totals.
Set 4:
Waist ___________+ Buttocks (females) ___________- Neck___________ = Total ___________
Add the three closest totals from sets 1-4 together then divide by three to find an average. Round the average
down to the nearest 0.5:
÷
( ______ + _______ + ______ )
3 = _______circumference value to enter in block 2
I agree that the above measurements are accurate (print and sign):
Member:___________________________________________
Cmnd Cadre &/or Witness:____________________________
Witness &/or entered by:______________________________
Record of Semi-Annual Weigh-In
DATE: _______________
EMPLID: ______________ NAME: ______________________________________________ AGE: _________
BLOCK 1: All members, initial screening, no shoes
HEIGHT
WEIGHT
Height
inches
58
131
Round up to nearest whole number
59
136
MAX Allowable weight per BMI table
pounds
60
141
61
145
Weight
62
150
Round down to nearest whole number
pounds
63
155
64
160
ODU w/ blouse – subtract 4.0 lbs.
65
165
Tropical Blue or organizational clothing– subtract 3 lbs.
66
170
T-shirt and trousers or sweatpants - subtract 2 lbs.
67
175
T-shirt and gym shorts - subtract 1 lb.
68
180
69
186
BLOCK 2: Body fat determination (if needed)
70
191
MAXIMUM BODY FAT
Enter MAX body fat
71
197
AGE
MEN
WOMEN
72
202
LESS THAN
73
208
22%
32%
%
30
74
214
LESS THAN
75
220
24%
34%
40
76
225
40 and above
26%
36%
77
231
inches
78
237
Enter Circumference Value as determined below
79
244
Enter Body fat from CIM 1020.8H enclosure (2)
%
80
250
Compliant? Y ___ N ___
Circumference Value determination:
Waist
+ Buttocks
- Neck
= Total
(females only, use 0
Round down to nearest half-inch.
for males) Round down to nearest
Round up to nearest half-
Measure over the bellybutton for
half-inch. Measure the widest point
inch, measure below
males, smallest point for females.
when viewed from side.
larynx
Set 1
+
-
=
Set 2
+
-
=
Set 3
+
-
=
Compare the three totals. Is any difference greater than 1.0?
Set 1 total _________ - Set 2 total __________ = ________
Set 2 total _________ - Set 3 total __________ = ________
Are any of these differences greater than 1.0?
Set 3 total _________ - Set 1 total __________ = ________
No.
All totals are within 1.0 inches of each other. Enter lowest total of the three sets as the Circumference
Value for block 2.
Yes.
Complete an additional set of measurements and then calculate an average circumference value using
only the three closest set totals.
Set 4:
Waist ___________+ Buttocks (females) ___________- Neck___________ = Total ___________
Add the three closest totals from sets 1-4 together then divide by three to find an average. Round the average
down to the nearest 0.5:
÷
( ______ + _______ + ______ )
3 = _______circumference value to enter in block 2
I agree that the above measurements are accurate (print and sign):
Member:___________________________________________
Cmnd Cadre &/or Witness:____________________________
Witness &/or entered by:______________________________