<p>Fitness Assessment Log</p><p>Membership # Date:</p><p>Name: D.O.B.:</p><p>Home Phone: Gender: M / F</p><p>Work Phone: Occupation:</p><p>Details</p><p>Date of assessment:</p><p>Girth Measurements Arm – R (cm)</p><p>Arm – L (cm) Chest (cm) Waist (cm) Hip (cm) Calf – R (cm) Calf – L (cm) Skin fold Measurements Biceps (mm) Triceps (mm) Subscapular (mm) Abdominal (mm) Suprailium (mm) Calf (mm) Total (mm)</p><p>Body fat (%) Flexibility Sit & Reach (mm) Shoulder (mm)</p><p>THIS FORM IS FOR TRAINING PURPOSES ONLY. Date of assessment:</p><p>Waist to Hip Ratio (WHR) Weight (kg) Height (cm) Body Mass Index (BMI) Resting Heart Rate (bpm) Blood Pressure (mm Hg) Muscle Endurance Tests Push ups Dips Sit-ups</p><p>Muscle Endurance Tests - Gym 20RM Shoulder Press 20RM Leg Press 20RM Lat Pull Down 20RM Bench Press</p><p>Muscle Strength Abdominals (Level) Chest Legs</p><p>4 km Time Trial (min) Cardiovascular Endurance (VO2)(ml/kg/min)</p><p>Cycle Ergonometer Time Load Heart rate Cadence 0 min 1 min 4 min 7 min 10 min</p><p>THIS FORM IS FOR TRAINING PURPOSES ONLY. Instructions for Use</p><p>Girth Measurements The measurements are made at the following positions. Arm Half way between the point of the elbow and the shoulder Chest At the line of the nipples with the person half way through a breath Waist In line with the umbilicus Hip At the level of the greatest girth of the buttocks posteriorly, standing with feet together Thigh At the crotch level and just below the gluteal fold Calf At the widest part of the calf</p><p>Skin fold Measurements Skin folds are measured in the following positions. Bicep On the anterior side of the right arm half way between elbow and shoulder. The crest of the fold is parallel with the axis of the humerus. Tricep On the posterior of the right arm half way between elbow and shoulder. The crest of the fold is parallel with the axis of the humerus. Subscapular 10 mm below the inferior angle of the right scapula. The crest of the fold runs at 45 degrees down and away from the spine. Abdominal Vertical fold 20 mm to the right of the umbilicus. Suprailium Diagonal fold in line with the natural line of the iliac crest taken in the anterior axillary line immediately superior to the iliac crest. Calf Vertical fold at the maximum circumference on the midline of the vertical border. Total A average of a total of 3 or 4 measurements are used to determine body fat composition. </p><p>Flexibility Sit & Reach The distance the slide is moved to as measured from the line of the feet. Distances less than the foot line are negative and distance beyond the foot line are positive. Shoulder The distance the fingers overlap or are apart. An overlap is a positive measurement and a gap is a negative measurement.</p><p>Waist to Hip Ratio (WHR) WHR = Waist Girth / Hip Girth. People with a Waist to Hip ratio greater than 0.9 for men and greater than 0.8 for women are considered to be at greater risk of health problems.</p><p>Body Mass Index (BMI) BMI = Mass(kg)/Height2. A body Mass index of greater than 27 kg/m2 is considered to indicate an elevated risk of cardiovascular disease.</p><p>Resting heart rate and blood pressure Resting Heart Measured in the sitting position by counting heart beats for 15 seconds and multiplying Rate by 4 Blood Pressure Measured in the sitting position </p><p>THIS FORM IS FOR TRAINING PURPOSES ONLY.</p>