Senior Citizen Fitness Assessment Sheet

Name

Date of Birth

Age

Assessment Date

Assessed By

Vital Signs

Blood Pressure

Pulse Rate

Respiratory Rate

Weight (kg)

Height (cm)

Functional Fitness Tests

Test	Score/Result	Notes
Chair Stand Test (30s)
Arm Curl Test (30s)
6-Minute Walk Test
Chair Sit-and-Reach Test
Back Scratch Test
2-Minute Step Test
8-Foot Up-and-Go (sec)

Mobility and Balance Assessment

Assessment	Result	Notes
Berg Balance Scale
Timed Up and Go (TUG)
Gait Speed (m/s)

Additional Notes & Recommendations