Employee Physical Fitness Assessment Form
Employee Name
Employee ID
Department
Date
Age
Gender
Male
Female
Other
Height (cm)
Weight (kg)
Assessment Parameters
Blood Pressure
Resting Heart Rate (bpm)
Flexibility (e.g. sit and reach)
Strength (e.g. push-ups in 1 min)
Endurance (e.g. 1.5-mile run time)
General Health Questions
History of chronic medical conditions
Recent illness or injury
Currently taking medication
Comments / Recommendations
Assessor Name
Assessor Signature