Form Sf195bas - Basic Training Physical Fitness Assessment Form
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1Ohio Peace Officer Training Commission
Office 800-346-7682
Fax 740-845-2675
P.O. Box 309
London, OH 43140
BASIC TRAINING PHYSICAL FITNESS ASSESSMENT FORM
School Name: _____________________________________________________School #: _______________________
Student’s Name: ___________________________________ ________________________________ _______________
(Last)
(First)
(Middle)
Previous Name(s) or Alias: __________________________________________________________________________
Sex: ______M
______F
DOB: _______________________
Age: ________________
Pre-entrance Assessment Date: ____________ Final Assessment Date: ____________ Retest Date: ____________
Status at Final Assessment:
______ Appointed
______ Open Enrollment
Age and Sex Minimum Scores
Males (<29)
Females (<29)
Pre-entrance
Final
th
th
th
th
15
%
50
%
15
%
50
%
Assessment
Assessment
Retest
th
15
percentile
(Score/P-F)
(Score/P-F)
th
th
50
percentile
50
percentile
Sit-ups (1 min.)
32
40
23
35
Push-ups (1 min.)
19
33
9
18
1.5 Mile Run
14:34
11:58
17:49
14:07
Males (30-39)
Females (30-39)
th
th
th
th
15
%
50
%
15
%
50
%
____________
____________
____________
# Sit-ups
# Sit-ups
# Sit-ups
Sit-ups (1 min.)
28
36
18
27
Completed
Completed
Completed
Push-ups (1 min.)
15
27
7
14
1.5 Mile Run
15:13
12:25
18:37
14:34
Males (40-49)
Females (40-49)
____________
____________
____________
th
th
th
th
15
%
50
%
15
%
50
%
# Push-ups
# Push-ups
# Push-ups
Completed
Completed
Completed
Sit-ups (1 min.)
22
31
13
22
Push-ups (1 min.)
10
21
5
11
1.5 Mile Run
15:58
13:11
19:32
15:24
Males (50-59)
Females (50-59)
____________
____________
____________
th
th
th
th
1.5 Mile Time
1.5 Mile Time
1.5 Mile Time
15
%
50
%
15
%
50
%
Sit-ups (1 min.)
17
26
7
17
Push-ups (1 min.)
7
15
4 (modified)
13 (modified)
1.5 Mile Run
17:38
14:16
21:31
17:13
____________
____________
____________
OVERALL
OVERALL
OVERALL
Males (60+)
Females (60+)
(P/F)
(P/F)
(P/F)
th
th
th
th
15
%
50
%
15
%
50
%
Sit-ups (1 min.)
13
20
2
8
Push-ups (1 min.)
5
15
1 (modified)
8 (modified)
1.5 Mile Run
20:12
15:56
23:32
18:52
th
Students must pass each event, at the minimum 50
percentile of the above 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 01/01/2017
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