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    Physical Activity Readiness Questionnaire (Par Q) : Regional Medical and Dental Unit 7

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    Kate Yurag
    This document is a physical activity readiness questionnaire (PAR Q) for applicants of the Philippine National Police undergoing a physical agility test. It contains 11 health-related questions about heart conditions, pain during physical activity, blood pressure, dizziness, bone or joint problems, and recent illnesses. Applicants must sign to confirm they understand the risks of the test and that any false information could affect their application. The form also includes spaces for the applicant's medical information like blood pressure and electrocardiogram results to be filled out.

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    Physical Activity Readiness Questionnaire (Par Q) : Regional Medical and Dental Unit 7

    Uploaded by

    Kate Yurag
    50 views2 pages
    This document is a physical activity readiness questionnaire (PAR Q) for applicants of the Philippine National Police undergoing a physical agility test. It contains 11 health-related questions about heart conditions, pain during physical activity, blood pressure, dizziness, bone or joint problems, and recent illnesses. Applicants must sign to confirm they understand the risks of the test and that any false information could affect their application. The form also includes spaces for the applicant's medical information like blood pressure and electrocardiogram results to be filled out.

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    This document is a physical activity readiness questionnaire (PAR Q) for applicants of the Philippine National Police undergoing a physical agility test. It contains 11 health-related questions about heart conditions, pain during physical activity, blood pressure, dizziness, bone or joint problems, and recent illnesses. Applicants must sign to confirm they understand the risks of the test and that any false information could affect their application. The form also includes spaces for the applicant's medical information like blood pressure and electrocardiogram results to be filled out.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    50 views2 pages

    Physical Activity Readiness Questionnaire (Par Q) : Regional Medical and Dental Unit 7

    Uploaded by

    Kate Yurag
    This document is a physical activity readiness questionnaire (PAR Q) for applicants of the Philippine National Police undergoing a physical agility test. It contains 11 health-related questions about heart conditions, pain during physical activity, blood pressure, dizziness, bone or joint problems, and recent illnesses. Applicants must sign to confirm they understand the risks of the test and that any false information could affect their application. The form also includes spaces for the applicant's medical information like blood pressure and electrocardiogram results to be filled out.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
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    Republic of the Philippines

    National Police Commission


    PHILIPPINE NATIONAL POLICE
    REGIONAL MEDICAL AND DENTAL UNIT 7
    Camp Sotero,Cabahug, Gorordo Avenue, Cebu City

    PHYSICAL ACTIVITY READINESS QUESTIONNAIRE (PAR Q)


    For Physical Agility Test (PAT)

    DATE:_______________________
    LAST NAME FIRST NAME AGE SEX CIVIL
    STATUS
    MIDDLE NAME

    NEXT OF KIN (NAME, RELATIONSHIP, ADDRESS, CONTACT NO.) CONTACT NUMBER

    PHYSICAL ACTIVITY READINESS QUESTIONNAIRE. This questionnaire is being given to the participant
    before any physical activity or exercise. This may be used for legal and/or administrative purposes.

    To be accomplished by the participant: Please read carefully and answer each one honestly: Encircle YES or NO.

    YES NO 1. Has your doctor ever said you have a heart condition and that you should only do physical activity
    recommend by a doctor?
    YES NO 2. Do you feel pain in your chest when you do physical activity?
    YES NO 3. In the past month, have you had chest pain even when you are not doing physical activity?
    YES NO 4. Do you experience shortness of breath or difficulty in breathing when doing physical activity?
    YES NO 5. Has any doctor ever said you have diabetes or increased blood sugar?

    YES NO 6. Have you had blood pressure over 140/90?


    YES NO 7. Do you lose balance because of dizziness or do you ever lose consciousness?
    YES NO 8. Do you have a bone or joint problem? For example knee or hip that could be made worse by a change in
    physical activity?
    YES NO 9. Have you had fever, cough, colds or even vehicular accident in the past week that required bed rest?
    YES NO 10. Do You have any surgeries in the past? If YES, When______________ what_______________?
    YES NO 11. Do you know any other reason why you should not do any physical activity?

    “I have read, understood and accurately completed this questionnaire. I attest that the above information are
    true and correct to the best of my knowledge. I confirm that I am voluntary engaging in this physical agility
    test and my participation involves a risk of injury. I understand that failure to disclose any pertinent medical
    information puts me at risk and can be held against me in my PNP application”

    ___________________________________ _______________________
    Name/Signature of Applicant Date
    FOR MEDICAL STAFF
    nd rd
    BP 2 BP 3 BP ECG RESULT: Encircle:

    GO
    PR 2nd PR 3rd PR

    NO GO _______________________________
    Signature over printed name of Medical Officer

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