BASIC TRAINING PHYSICAL ASSESSMENT FORM
School Name: _____________________________________________________School #: _______________________
Student’s Name: ___________________________________ ________________________________ _______________
(Last) (First) (Middle)
Previous Name(s) or Alias: __________________________________________________________________________
Sex: ______M ______F DOB: _______________________ Age: ________________
Initial Assessment Date: ____________ Final Assessment Date: ____________ Retest Date: ____________
Status at Final Assessment: ______ Appointed ______ Open Enrollment
Age and Gender Minimum Scores
Males (<29) Females (<29)
Sit-ups (1 min.)
Push-ups (1 min.)
1.5 Mile Run
15%
32
19
14:34
50%
40
33
11:58
15%
23
9
17:49
50%
35
18
14:07
Initial
Assessment
Final
Assessment
(Score/P-F)
Retest
(Score/P-F)
Males (30-39) Females (30-39)
Sit-ups (1 min.)
Push-ups (1 min.)
1.5 Mile Run
15%
28
15
15:13
50%
36
27
12:25
15%
18
7
18:37
50%
27
14
14:34
____________
# Sit-ups
Completed
____________
# Sit-ups
Completed
____________
# Sit-ups
Completed
Males (40-49) Females (40-49)
Sit-ups (1 min.)
Push-ups (1 min.)
1.5 Mile Run
15%
22
10
15:58
50%
31
21
13:11
15%
13
5
19:32
50%
22
11
15:24
____________
# Push-ups
Completed
____________
# Push-ups
Completed
____________
# Push-ups
Completed
Males (50-59) Females (50-59)
Sit-ups (1 min.)
Push-ups (1 min.)
1.5 Mile Run
15%
17
7
17:38
50%
26
15
14:16
15%
7
4 (modified)
21:31
50%
17
13 (modified)
17:13
____________
1.5 Mile Time
____________
1.5 Mile Time
____________
1.5 Mile Time
Males (60+) Females (60+)
Sit-ups (1 min.)
Push-ups (1 min.)
1.5 Mile Run
15%
13
5
20:12
50%
20
15
15:56
15%
2
1 (modified)
23:32
50%
8
8 (modified)
18:52
____________
OVERALL
(P/F)
____________
15% (Y/N)
____________
OVERALL
(P/F)
____________
OVERALL
(P/F)
Students must pass each event, at the minimum 50
th
percentile of the Cooper Institute standards, in order to be eligible for the state certification exam.
_______________________________ _____________ ________________________________ ____________
Fitness Specialist Signature Date Commander Signature Date
_______________________________ _____________ ________________________________ ____________
Fitness Specialist Signature Date Commander Signature Date
_______________________________ _____________ ________________________________ ____________
Fitness Specialist Signature Date Commander Signature Date
SF195bas Effective 07/01/2016
Ohio Peace Officer Training Commission
Office 800-346-7682
Fax 740-845-2675
P.O. Box 309
London, OH 43140
w
ww.OhioAttorneyGeneral.gov
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