Unit 6: Fitness testing for sport and exercise - Pearson Schools

[42]
BTEC National Sport Assessment and Delivery Resource
Are you currently taking any kind of medication? _______________________________________________
_______________________________________________________________________________________
Have you been in hospital within the last six months? YES/NO
If so regarding what? _____________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
Have you had any recent surgery? ___________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
Do you have any allergies? YES/NO
If so what allergies do you have? ____________________________________________________________
_______________________________________________________________________________________
Do you have high blood pressure? YES/NO
Do you have any current or recurring injuries? YES/NO
If so what? _____________________________________________________________________________
_______________________________________________________________________________________
Do you take regular exercise? YES/NO
If so, how many hours a week? ______________________________________________________________
_______________________________________________________________________________________
Are you pregnant or post-natal? YES/NO
Do you smoke? YES/NO
Do you have diabetes? YES/NO
Disclaimer’s signature: ___________________________________ Date: ___/___/____
© Harcourt Education Ltd 2007. Copying permitted for purchasing institution only. This material is not copyright free.