Physical Ability Test (PAT) Assessment Form
Complete this form to document participant details, health screening, test performance, and assessment outcomes.
Participant Full Name
*
First Name
Last Name
Date of Birth
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Contact Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Assessment Date and Time
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
PAT Event/Test Type
*
Please Select
1.5 Mile Run
Push-Ups
Sit-Ups
Vertical Jump
Agility Test
Other
Health Screening: Please indicate if the participant has any of the following conditions today.
*
Fever or illness
Recent injury
Chest pain or shortness of breath
No health issues
Other
Physical Readiness: Has the participant confirmed they feel fit and prepared to complete the test?
*
Yes, fully prepared
Somewhat prepared
No, not prepared
PAT Performance Results
*
Rows
Result
Score
Rating (1=Poor, 5=Excellent)
Cardio Endurance
1
Muscular Strength
2
Muscular Endurance
3
Flexibility
4
Agility/Speed
5
Assessor Observations and Comments
Overall Outcome
*
Pass
Fail
Follow-Up Actions or Recommendations
Submit Assessment
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