Title Page

  • Site

  • Conducted on

  • Prepared by

  • Location

General Information

  • Name

  • Age

  • Wt

  • Ht

  • Medications

  • Risk Factor Status

  • Resting HR

  • Resting BP (1)

  • Resting BP (2)

  • Skinfolds

  • Pectoral

  • Abdomen

  • Thigh

  • Triceps

  • Suprailiac

  • Thigh

  • Estimated % Body Fat Waist to Hip Ratio (divide waist by hip)

  • BMI

  • Circumferences:

  • Hip

  • Waist

  • Thigh

  • Calf

  • Upper arms

  • Forearm

Step Test

  • Step Test (60 sec. HR)

  • Rockport Walking Test (60 sec. HR)

  • Comments

Abdominal Strength

  • Bench Press 1 RM

  • Weights (lbs)

  • Total Bench Press

  • Crunch Test (#/min.)

  • Push-up Test (total #)

  • Sit and Reach (inches)

Muscle Specific Flexibility Test

  • Hamstrings

  • Iliopsoas

  • Quadriceps

  • Calves

  • Shoulders

Posture Assessments (visual)

  • Take a photo

  • Lordosis

  • Kyphosis

  • Forward head

  • Hip height discrepancy

  • Shoulder height

Sign Off

  • Prepared by

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.