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Miller Health
Fit for Work Home
Principles
Readiness Questionnaire
Indemnity
Measuring and Managing the risk
Newsletter
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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.
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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.
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Yes
o
No o |
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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.
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Yes
o
No o |
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3. |
Have you ever
had heart disease or dysfunction?
If yes provide
details.
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Yes
o
No o |
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4. |
Are you
currently on medication for high blood pressure? |
Yes
o
No o |
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5. |
Are you
currently on medication for adult onset diabetes? |
Yes
o
No o |
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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 |
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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 |
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9. |
Do you suffer
from epilepsy? |
Yes
o
No o |
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10. |
Do you suffer
from fainting/dizzy spells? |
Yes
o
No o |
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11. |
Are you
currently on medication for depression? |
Yes
o
No o |
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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.
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Yes
o
No o |
……………………………………............... ……../……../……..
Signed Date
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