Physical readiness testing liability release



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PHYSICAL READINESS TESTING LIABILITY RELEASE

Wisconsin Department of Transportation

SP4412 11/2015










Instructions: Read the following information. Complete the bottom portion of the form. This release must be completed and turned in at your scheduled physical readiness testing. The information obtained on this release is used exclusively for the purpose of verifying pre-employment consideration.
Wisconsin State Patrol Trooper/Inspector Physical Readiness Testing

Vertical Jump

a) The participant stands under the apparatus and reaches up as high as possible to mark his/her standing reach.

b) The coordinator adjusts the stack of tabs to a point immediately above the tips of the fingers.

c) The participant steps back with either foot, steps forward then jumps as high as possible and strikes the tabs OR the participant may jump with both feet and not take a step.

d) The score is the inches jumped to the nearest ½ inch.

e) The best of three (3) trials is the score.

f) The entrance standard is 11.5 inches.
Illinois Agility Run

a) The participant lies, face down, on the ground with fingertips behind the start line.

b) At the "GO" start, the participant gets up, sprints to the other line (30 feet away) places one foot over the line then sprints back to the start line.

c) The participant makes a left turn around the first cone then zig zags in a figure eight fashion around the four cones and back to the start line.

d) The participant then sprints up and back as described in (b).

e) The finish time is recorded in seconds and tenths.

f) Participants will be allowed one slow walk through and two (2) trials. The score is the best (lowest) time.

g) The entrance standard is 23.4 seconds.


One Minute Sit-Up Test

a) The participant starts by lying on his/her back, knees bent, and heels flat on the floor. Finger tips stay behind the ears.

b) A partner holds the feet down.

c) The participant then performs as many correct sit-ups as possible in one minute.

d) In the up position, the participant must touch or extend pass the knees with the elbows, then return the shoulders to the ground before starting the next sit up. The participant may rest momentarily in the ‘up’ position.

e) The participant cannot raise the buttocks from the ground and when returning to the down position the shoulder blades must touch the ground.

f) Score is total number of correct sit-ups in 1 minute.

g) The entrance standard is 24 sit-ups.


300 meter run

a) The participant will be allowed five minutes to warm up.

b) At "GO" the participant runs the 300 meter course as fast as possible.

c) The time it takes to complete the course is recorded.

d) The entrance standard is 82 seconds.
Push-Up Test

a) The participant starts in the front leaning rest position. Hands are slightly more than shoulder width apart; feet are 12" apart or less.

b) The participant lowers self until the upper arms are parallel to the ground, then pushes up again.

c) The back must be kept straight throughout the exercise.

d) There is no time limit. The score is the correct number of push-ups.

e) The entrance standard is 18 push-ups.


1.5 Mile run

a) Participants will be allowed to warm up.

b) Participants should be instructed to cover the distance as fast as possible.

c) At the command "GO" time is started.

d) Score is time (min:sec) to run the course.

e) A cool down is required after running.

f) The entrance standard is 20:20.


Applicant Name - Last, First, Middle

     


I certify that I have read the above-described physical readiness testing standards and can perform the test.










(Applicant Signature)

(Date)



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