Physical activity readiness form

About this physical activity readiness form

Before someone starts a new exercise program, class or sport, a short readiness questionnaire checks for warning signs that need a doctor’s advice first: heart problems, chest pain, dizziness, high blood pressure, bone or joint problems and medicines that affect exercise. It’s modelled on the widely used PAR-Q approach.

Anyone answering “yes” to a question should talk to a doctor before becoming much more active. Trainers can then record a baseline with the fitness assessment form.

What’s on the physical activity readiness form

The template has 3 sections and 15 questions. Every one can be renamed, moved or deleted.

• Participant: Name; Age; Date; Activity or program
• Please answer every question: Has a doctor ever said you have a heart condition or high blood pressure? (yes or no); Do you feel pain in your chest at rest, during daily activities or when you exercise? (yes or no); Do you lose balance because of dizziness, or have you lost consciousness in the last year? (yes or no); Have you been diagnosed with another long-term condition (other than heart disease or high blood pressure)? (yes or no); Are you taking prescribed medicines for a long-term condition? (yes or no); Do you have a bone, joint or soft-tissue problem that could get worse with more activity? (yes or no); Has a doctor said you should only do medically supervised activity? (yes or no); Are you pregnant or have you given birth in the last six months? (yes or no)
• Declaration: Agreement: “I have answered honestly and will tell the instructor if my health changes.”; Participant signature with date; Parent or guardian signature (under 18) with date

Tips

• Ask people to repeat the form if their health changes.
• Don’t give medical advice yourself; refer “yes” answers to a doctor.
• Keep completed forms with the participant’s waiver.

Four ways to save it

A fillable PDF has typing boxes, tick boxes and choices built in. A printable PDF gives clean boxes and writing lines for pen and paper. The Word file can be edited further, and the HTML code adds the same questions to a website. Browse more form templates, or design a completely different layout in the custom form builder.