SCHOOL NAME
COMPLETE NAME
Last Name
Given Name
TEACHER'S NAME
FIRST QUARTER
PART 1: HEALTH RELATED FITNESS TEST
A. Body Composition: Body Mass Index (BMI)
Height (m)
Weight (kgs)
BMI
Classification
SCHOOL YEAR:
SEX
Middle Name
BIRTHDATE:
AGE
SECOND QUARTE
PART 1: HEALTH RELATED FITNESS TES
A. Body Composition: Body Mass Index
Height (m)
Weight (kgs)
C. Strength:
1. Push-up
Number of Push ups
2. Basic Plank
Time
C. Strength:
1. Push-up
Number of Push ups
D. Flexibility:
1. Zipper Test
Overlap / Gap (Cm)
Right
Left
D. Flexibility:
1. Zipper Test
Overlap / Gap (Cm)
Right
Left
3rd
Average
2. Sit and R
1st
4th Trial
THIRD QUARTER
PART 1: HEALTH RELATED FITNESS TEST
A. Body Composition: Body Mass Index (BMI)
Height (m)
Weight (kgs)
BMI
Classification
FOURTH QUARTE
PART 1: HEALTH RELATED FITNESS TES
A. Body Composition: Body Mass Index
Height (m)
Weight (kgs)
C. Strength:
1. Push-up
Number of Push ups
2. Basic Plank
Time
C. Strength:
1. Push-up
Number of Push ups
D. Flexibility:
1. Zipper Test
Overlap / Gap (Cm)
Right
Left
D. Flexibility:
1. Zipper Test
Overlap / Gap (Cm)
Right
Left
3rd
Average
2. Sit and R
1st
4th Trial
RD
OL YEAR:
2015-2016
EX
HDATE:
AGE
OND QUARTER
ITNESS TEST
Mass Index (BMI)
BMI
Classification
3rd
NESS TEST
Counter-clockwise(00.00)
Average
Time
ump
ance (cm)
Second Trial
Stand Test
Left Foot : Time (00.00)
p Test
3rd Trial
4th Trial
RTH QUARTER
ITNESS TEST
Mass Index (BMI)
BMI
Classification
3rd
NESS TEST
Counter-clockwise(00.00)
Time
ump
ance (cm)
Second Trial
Stand Test
Left Foot : Time (00.00)
p Test
3rd Trial
4th Trial
Average
Division of La Union
Caba District
Grade Leve
School Y
40 Meter
Sprint
Time
Basic
Plank
Zipper
Test
Sit and
Reach
Juggling
Ave
Hexagon Agility
Test (Time)
Push up
CW
Speed
Score
BMI
Classificatio
n
(N,OW,UW,O
)
Agility
Left (cm)
Height
(kg)
Coordinati
on
Right
(cm)
Name of Pupils/Student
Flexibility
Time
Body Composition
Weight(m)
1A
2B
3c
Strength
No. of
Push ups
Nos.
Cardiovascular
Endurance
SKILL
CCW
REL
Prepared by:
AMIE LYN L. SOBREVILLA
TEACHER
June 09,2015
Date Conducted:
Noted by:
Approved:
MERIZA Q. LOZANO
School Head
JOAQUIN A
Public Schools Dis
Grade Level:
RELATED FITNESS
3rd Trial
2nd Trial
1st Trial
Stork Balance
stand Test
(Time)
Left ft.
Standing Long
Jump (cm)
Right ft.
Reaction Time
2nd Trial
Balance
1st Trial
Power
Middle
Score
SKILL
OAQUIN A ABELLERA
Schools District Supervisor