Civilian Use of Army Obstacle Courses Physical Activity Readiness Questionnaire

ALL INFORMATION WILL BE TREATED CONFIDENTIALLY

1.  Please complete the necessary details below.

2. Cadet Name…………………………………… - TWGGS cadet

Question / Please Choose
1 / Has a doctor ever said that this cadet has a heart condition and that they should only do physical activity recommended by a doctor? / Yes / No
2 / Is a doctor currently prescribing medication (for example water pills) for blood pressure or a heart problem? / Yes / No
3 / Does this cadet ever feel pain in their chest when they do physical activity? / Yes / No
4 / In the past month, has this cadet had any chest pain when not doing physical activity? / Yes / No
5 / Does this cadet ever feel faint or have spells of dizziness? / Yes / No
6 / Does this cadet suffer from shortness of breath at any time? / Yes / No
7 / If this cadet suffers from asthma, including exercise induced asthma, is there any reason why they should not participate in the activities? / Yes / No
8 / Does this cadet have a joint problem (including neck, back & hip problems) that could be made worse by exercise, including jumping and landing? / Yes / No
9 / Is the participant aged 60yrs or older? / Yes / No
10 / Is the participant pregnant or has given birth over the last 6 months? / Yes / No
11 / Is the cadet taking any medication that would effect/exclude them from taking part in the activity? / Yes / No
12 / Are there any other reasons why they should not participate in physical activity? If so please state: / Yes / No

3. Please be aware that if any of the above questions have been answered ‘Yes’ the cadet will not be able to participate in the activity.

4. If you have completed this PAR-Q in advance of the scheduled activity and the cadets health status changes prior to the start of the activity the instructors must be informed.

5. The cadet’s ability to undergo the activity will be monitored during the warm up which will also provide a functional assessment of the cadets ability to proceed onto the obstacle course. If the instructor determines that, based on the assessment, the cadet is not of the required standard then the cadet may be refused access to the obstacle course.

6. I have read, understood and completed all questions within this questionnaire to my full satisfaction.

Please Sign Here: …………………… Print Name: ………………………… Date: ……………..

Instructor Sign Here: ………………… Print Name: ………………………… Date: ……………..