Fitness Assessment Form - Powerhouse Gym
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1
2FITNESS ASSESSMENT FORM
NAME:______________________________________MEMBERSHIP NO.________________
TRAINER:______________________________________________________________________
BIRTH DATE:___________________________________________________________________
MALE:_______________________________ FEMALE:____________________________________
HEIGHT:________________________________________________________________________
CURRENT WEIGHT:
__
CLASSIFICATION:
____________
•
HEALTHY WEIGHT:________________
CURRENT BMI: __
CLASSIFICATION: ____________
•
HEALTHY BMI:_________________
BODY FAT % ASSESSMENT
MEN/WOMEN
SKIN FOLD SITE
MEASUREMENT (mm)
CHEST
MIDAXILLARY
TRICEP
SUBSCAPULAR
ABDOMEN
SUPRAILIAC
THIGH
BODY FAT %:_________ OPTIMAL BODY FAT %_________
Men
7 Site Formula (chest, midaxillary, triceps, subscapular, abdomen, suprailiac, thigh)
Body Density (BD)= 1.112 - 0.00043499 x (Sum of 7Skinfolds) + 0.00000055 x ( Sum of 7 Skinfolds)^2 – 0.00028826
Body Density (BD)= 1.112 - 0.00043499 x (________)+ 0.00000055 x (_______)^2 – 0.00028826 x _____
Women
Body Density = 1.097 - 0.00046971 x (Sum of 7Skinfolds) + 0.00000056 x ( Sum of 7 Skinfolds)^2 – 0.0002826 x age)
Body 7 Site Formula (chest, midaxillary, triceps, subscapular, abdomen, suprailiac, thigh)
Density = 1.097 - 0.00046971 x _____ + 0.00000056 x (_____)^2 – 0.0002826 x _____
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