Form A

Department of Education
Region X-Northern Mindanao
DIVISION OF MALAYBALAY CITY
Purok 6, Casisang, Malaybalay City
_______________________________________________________________________________

PHYSICAL FITNESS TEST (PFT) SCORE CARD

S.Y. 2016 - 2017

NAME: ___________________________________ GRADE/SECTION: __________________AGE: _____ SEX: ____

SCHOOL: _________________________________ DISTRICT: ______________ BIRTHDAY: __________________

PART I. HEALTH – RELATED FITNESS TEST

PARAMETERS ACTIVITIES PRE-TEST POST-TEST

(1st Quarter) (4th Quarter)
Body Mass Index (BMI)  Height (meters)
A. BODY  Weight (kilograms)
COMPOSITION BMI = Weight (kg.)  BMI
Height (m)2  Classification
Heart Rate Per Minute
B. CARDIOVASCULAR 3 – Minute Step Test  Before the Activity
ENDURANCE Heart Rate Per Minute
 After the Activity
Heart Rate Recovery
C. STRENGTH 90 Degrees Push-Up  Number of Push-Up
Basic Plank  Time (00:00)
Zipper Test Overlap Gap – Right Arm (cm)
D. FLEXIBILITY Overlap Gap – Left Arm (cm)
 First Try
Sit and Reach (cm)  Second Try
 Best Score

PART II. SKILL – RELATED FITNESS TEST

PARAMETERS ACTIVITIES PRE-TEST POST-TEST

A. COORDINATION Juggling  Score: Number of Hits
 Clockwise Time (00:00)
B. AGILITY Hexagon Agility Test  Counter Clockwise Time
C. SPEED 40 Meter Sprint  Time (00:00)
 First Trial (cm)
D. POWER Standing Long Jump  Second Trial (cm)
(distance in cm)  Middle Score (cm)
Stork Balance Stand  Right Foot Time (00:00)
E. BALANCE Test  Left Foot Time (00:00)
 First Trial (cm)
F. REACTION TIME Stick Drop Test  Second Trial (cm)
 Third Trial (cm)
 Middle Score (cm)

______________________________________ __________________________________
Name of MAPEH Teacher Name of MAPEH Dept. Head