Ergo Consulting
Ergonomic Training
Workplace Risk Analysis
Ergonomic Audits
Engineering Solutions
Physical Demands Analysis
Job Rotation
Manual Handling Training
Ergonomic Expert Witness
Early Intervention
Early Intervention Services
Physical Ability Testing
Physical Ability Testing
Portal Access
Technical
Muscle Fatigue (EMG)
Biomechanical Modeling
Work Intensity (METs)
Heat Stress
Ergonomic Product Certification
Product Usability & Design
Workplace Simulation
Get Certified
CEPS®
Resources
Testimonials
Where We Work
Blog
Contact
Ergo Consulting
Ergonomic Training
Workplace Risk Analysis
Ergonomic Audits
Engineering Solutions
Physical Demands Analysis
Job Rotation
Manual Handling Training
Ergonomic Expert Witness
Early Intervention
Early Intervention Services
Physical Ability Testing
Physical Ability Testing
Portal Access
Technical
Muscle Fatigue (EMG)
Biomechanical Modeling
Work Intensity (METs)
Heat Stress
Ergonomic Product Certification
Product Usability & Design
Workplace Simulation
Get Certified
CEPS®
Resources
Testimonials
Where We Work
Blog
Contact
Physical Ability Testing Protocol – Part 1
Name
(Required)
First
Last
Are you presently restricted from lifting or pulling by any physician?
(Required)
Yes
No
Have you recently had any surgery that should limit your lifting or pulling?
(Required)
Yes
No
Are you presently placed on medical limitations by your employer or doctor?
(Required)
Yes
No
Has your doctor ever said you have heart trouble?
(Required)
Yes
No
Are you having back pain?
(Required)
Yes
No
Do you have high blood pressure (greater than 140/90)?
(Required)
Yes
No
Have you recently experienced chest discomfort with exertion or shortness of breath for no apparent reason?
(Required)
Yes
No
Do you often feel faint or have spells of severe dizziness?
(Required)
Yes
No
Have you ever had a blood clot?
(Required)
Yes
No
Where was the blog clot located in your body?
When was the blood clot discovered?
MM slash DD slash YYYY
Do you currently have an infection?
(Required)
Yes
No
Do you currently have an uncontrolled metabolic disease (diabetes, thyrotoxicosis, gout, myxedema, etc.) or serious disorder (mononucleosis, hepatitis, etc.)?
(Required)
Yes
No
Has your doctor ever told you that you have a bone, joint or musculoskeletal problem, such as arthritis or sciatica, that has been made worse by exercise or are you currently under medical care for any bone, joint or musculoskeletal problem?
(Required)
Yes
No
Are you currently taking any prescription or non-prescription medication that alter your heart rate ?
(Required)
Yes
No
What is the name of medication
When was the medication taken last?
Are you currently experiencing asthmatic symptoms, and/or do you experience asthmatic symptoms with exercise?
(Required)
Yes
No
Are you on daily medication for asthmatic symptoms?
(Required)
Yes
No
What is the name of medication?
When was the medication taken last?
Are you pregnant?
(Required)
Yes
No
Is there a good physical reason not mentioned here why you should not perform these tests even if you wanted to?
(Required)
Yes
No
Consent
(Required)
By checking this box, I understand the above questions and have answered them truthfully to the best of my knowledge. I feel physically able to perform the strength and step tests.
(Required)
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