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Republic of the Philippines

Department of Education
Region XI
Division of Davao del Sur
Santa Cruz North District
TIBOLO ELEMENTARY SCHOOL
PFSTT Year End Consolidation Form
Grade Level: _______________________
PART I. - Physical Fitness Components/health related Components

Name of Student

Nutritional
Fitness

Cardiovascular
Endurance

Flexibility

Muscular
Strength

Power
Speed
Evaluation

3-min Step Test Zipper Test

Curl Ups

Part II - Skill Related Compon


Agility

Reaction Time

Coordincation

Stick Drop
(cm)

Paper Juggling

40 meter Hexagon Agility


Sprint (m)
Test (min)

BMI
CI

L
R

L
R

C
CC

C
CC

A
V

A
V

BMI
CI
BMI
CI
BMI
CI
BMI
CI
BMI
CI
BMI
CI
BMI
CI
BMI
CI
BMI
CI
BMI
CI

L
R
L
R
L
R
L
R
L
R
L
R
L
R
L
R
L
R
L
R

L
R
L
R
L
R
L
R
L
R
L
R
L
R
L
R
L
R
L
R

C
CC
C
CC
C
CC
C
CC
C
CC
C
CC
C
CC
C
CC
C
CC
C
CC

C
CC
C
CC
C
CC
C
CC
C
CC
C
CC
C
CC
C
CC
C
CC
C
CC

A
V
A
V
A
V
A
V
A
V
A
V
A
V
A
V
A
V
A
V

A
V
A
V
A
V
A
V
A
V
A
V
A
V
A
V
A
V
A
V

Pre-test Conducted: ______________

Post Test Conducted: ________________

Prepared by:
MAPEH/MESPK TEACHER
Name of Student

PART I. - Physical Fitness Components/health related Components


Muscular
Power
Cardiovascular
Flexibility
Nutritional
Endurance
Strength
Speed
Evaluation
40 meter
Fitness
3-min Step Test Zipper Test Curl Ups
Sprint (m)
BMI
L
L
CI
R
R
BMI
L
L
CI
R
R
BMI
L
L
CI
R
R
BMI
L
L
CI
R
R
BMI
L
L
CI
R
R
BMI
L
L
CI
R
R
BMI
L
L
CI
R
R
BMI
L
L
CI
R
R
BMI
L
L
CI
R
R
BMI
L
L
CI
R
R
BMI
L
L
CI
R
R
BMI
L
L
CI
R
R
BMI
L
L
CI
R
R
BMI
L
L
CI
R
R

Part II - Skill Related Compon


Agility
Hexagon Agility
Test (min)
C
C
CC
CC
C
C
CC
CC
C
C
CC
CC
C
C
CC
CC
C
C
CC
CC
C
C
CC
CC
C
C
CC
CC
C
C
CC
CC
C
C
CC
CC
C
C
CC
CC
C
C
CC
CC
C
C
CC
CC
C
C
CC
CC
C
C
CC
CC

Reaction Time Coordincation


Stick Drop
Paper Juggling
(cm)
A
A
V
V
A
A
V
V
A
A
V
V
A
A
V
V
A
A
V
V
A
A
V
V
A
A
V
V
A
A
V
V
A
A
V
V
A
A
V
V
A
A
V
V
A
A
V
V
A
A
V
V
A
A
V
V

BMI
CI
BMI
CI
BMI
CI

L
R
L
R
L
R

L
R
L
R
L
R

C
CC
C
CC
C
CC

C
CC
C
CC
C
CC

A
V
A
V
A
V

A
V
A
V
A
V

omponents/ Sports Talent Components


Balance

Muscle Power

Stork
Balance Test

Basketaball Standing Long


Pass
Jump

EVALUATION

_____
Noted by:

KENNETH M. ALAIR
School Head
omponents/ Sports Talent Components
Balance
Stork
Balance Test

Muscle Power
Basketaball Standing Long
Pass
Jump

EVALUATION

PHYSICAL FITNESS RESULTS

HEALTH RELATED COMPONENTS


Three Minute Step Test
Result
Male
Female
Excellent
< 71
<97
Good
71 - 102
128-197
Fair
103-117
128-142
Poor
118-147
143-171
Very Poor
148+
172+
Zipper Test
Passed or Failed
L - Left Hand R - Right Hand
Curl-Ups
Result
Male
High Performance
41+
Fgood Fitness
21-40
Marginal
18-20
Low Fitness
17-

Female
33+
18-32
15-17
14-

SKILL-RELATED COMPONENTS
Hexagon Agility Test
Record the time till the pupil is able to
complete the test C - Clocwise CC Counter clockwise

Result
Excellent
Good
Average
Fair
Poor

Stork Balance
Male and Female
50+ Seconds
40-50
25-39
11-24
10 below

Result
Excellent
Good
Fair
Poor

Paper Juggling
Male and Female
15+
10-14
9-5
5 below
Stick Drop Test

Record the A (audio) and V for Visual


Reaction in centimeters
40 Meter Sprint
Result
Male and Female
Excellent
6 Seconds
Good
7-9
Fair
9-11
Poor
12-15
Very Poor
15+
Basketball Pass and Standing Long
Jump
Result
Male
High Performan 203-228 m
Fgood Fitness 118-202
Marginal
Low Fitness

167-187
142-166

D COMPONENTS

Agility Test

l the pupil is able to


t C - Clocwise CC clockwise

Balance
Male and Female
50+ Seconds
40-50
25-39
11-24
10 below

Juggling
Male and Female
15+
10-14
9-5
5 below

rop Test

dio) and V for Visual


centimeters

er Sprint
Male and Female
Seconds
-9
-11
2-15
5+

and Standing Long


mp
Female
108-203 m
162-179
147-161
121-143