Template Checklist Forms Physical Assessment Checklist Template

Physical Assessment Checklist Template

Physical Assessment Checklist Template

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Questions
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Physical Assessment Checklist Template

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*
1. Basic Personal Info
Full Name
Full Name
Date of Birth
Date of Birth
Height
Height
Weight
Weight
Phone Number
Phone Number
*
2. Overall Physical Health Status
Excellent, fully healthy with no discomfort
Good, occasional minor physical fatigue
Fair, frequent body soreness or sub-health
Poor, have chronic physical symptoms
*
3. Cardiopulmonary Function Level
Very good, no breathlessness after exercise
Normal, slight breathlessness after moderate exercise
Weak, obvious breathlessness after mild exercise
Abnormal, need professional medical examination
*
4. Daily Physical Mobility & Flexibility
Fully flexible, free limb movement
Slightly stiff, no movement obstacles
Limited joint movement occasionally
Obvious joint pain & movement restriction
*
5. Chronic Medical Condition History
No chronic diseases at all
Mild chronic allergy only
Stable chronic underlying disease
Uncontrolled chronic illness
*
6. Recent Physical Injury Record (Within 6 months)
No trauma or sports injury
Minor healed bruise/sprain
Unhealed mild body injury
Severe surgery or bone injury
*
7. Sleep Quality Condition
High-quality, stable long sleep
Normal sleep, occasional insomnia
Poor sleep, frequent waking up
Severe insomnia & sleep disorder
*
8. Regular Medication Situation
No long-term medication
Occasional emergency medicine use
Fixed daily medication needed
Long-term dependent medication
*
9. Doctor-restricted Exercise Items
No restricted sports or activities
Forbidden from high-intensity workouts
Forbidden from outdoor strenuous exercise
Need low-intensity activity only
*
10. Recent Mental & Fatigue Level
Energetic all day
Mild fatigue after work
Persistent physical tiredness
Severe burnout & physical exhaustion
11. Medical Remarks & Special Notes
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Template instructions

The physical assessment checklist template is a streamlined health screening tool suited for gym coaches, corporate HR admins, school nurses and sports program supervisors to record personal physical conditions systematically.


It features standardized fields tracking vital fitness levels, injury history, chronic illnesses, sleep quality and activity restrictions with clear selectable options for quick completion.


Adjust evaluation items to match employee wellness checks, athlete pre-training screenings or regular personal health tracking, then distribute digitally to gather unified health data instantly.


All gathered records help arrange safe workout plans, workplace wellness arrangements and targeted medical follow-ups.


Click "Use This Template" to simplify physical evaluation workflows and maintain complete, organized health assessment records effortlessly.

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1

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2

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3

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