ASSESSMENTS HOME
Universal Fitness Test Home
Principles
Readiness Questionnaire
Indemnity
Measuring and Managing the risk
in the workplace
|
FITNESS ACTIVITY READINESS
QUESTIONNAIRE
Please complete the
Fitness Activity Readiness Questionnaire (FAR-Q), providing details
of any of the injuries, illnesses, health conditions, disabilities
and dysfunctions you currently have or may have had, and which will affect
your ability to take part in a fitness program.
1. |
Do you have a
regular aerobic fitness training program?"
If yes provide
details of the nature, frequency, intensity and duration of
your exercise program.
.....................................................................................
.....................................................................................
|
Yes
o No o |
|
|
|
2. |
Do you have a regular and
systematic strength training program?
If yes provide
details of the nature, frequency, intensity and duration of
your exercise program.
......................................................................................
......................................................................................
|
Yes
o No o |
|
|
|
3. |
Have you ever
had heart disease or dysfunction?
If yes provide
details.
......................................................................................
......................................................................................
|
Yes
o No o |
|
|
|
4. |
Are you
currently on medication for high blood pressure? |
Yes
o No o |
|
|
|
5. |
Are you
currently on medication for adult onset diabetes? |
Yes
o No o |
|
|
|
6. |
Do you suffer
from asthma in a way which would prevent you from from being
involved in continuous exercise of a vigorous and strenuous
nature? |
Yes
o No o |
|
|
|
7. |
Do you have any
bone or joint problems which would prevent you from being involved in continuous
exercise of a vigorous and
strenuous nature? |
Yes
o No o |
|
|
|
9. |
Do you suffer
from epilepsy? |
Yes
o No o |
|
|
|
10. |
Do you suffer
from fainting/dizzy spells? |
Yes
o No o |
|
|
|
11. |
Are you
currently on medication for depression? |
Yes
o No o |
|
|
|
12. |
Is there
anything at all about your health that you feel you should
disclose before you participate in an assessment of your
physical fitness. If yes, provide details.
.....................................................................................
.....................................................................................
....................................................................................
.....................................................................................
.....................................................................................
|
Yes
o No o |
……………………………………............... ……../……../……..
Signed Date
Miller Health
7 Salvado Place, Stirling (Canberra) ACT
2611 Australia
(02) 6288 7703 |