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Forms and Documents

Proper Use: Important Please Read

Fitness managers and exercise professionals are free to use (and edit) any of these forms and documents. All of these forms/documents are “Word” docs that can be easily changed/edited. Some of these forms have “copyright” stated at the bottom. When using/editing these forms in your facility and programs, feel free to remove the copyright statement. However, if you choose to publish any of these forms/documents in print or electronically (e.g., in a book, book chapter, journal article, magazine/newspaper, Internet website, thesis/dissertation), a copyright statement AND formal permission from Dr. Eickhoff-Shemek ( are required.

Chapter 2 Employee Safety Culture Survey

Chapter 6 PASQ Forms (Appendix 6)


Form 6-1 PASQ Cover Letter

Form 6-2 PASQ – Professionally-Guided

Form 6-3 PASQ Interpretation Form

Form 6-4 PASQ Medical Clearance Form

Form 6-5 PASQ – Self-Guided

See: Putting the New ACSM's Pre-Activity Health Screening Guidelines into Practice

This article includes these PASQ forms, description on how to implement them, and legal issues applicable to pre-activity screening. Please read Chapter 6 and this article before using any of these forms.

Chapter 8 Lesson Plan and Lesson Plan Evaluation Templates

Chapter 8 Performance Appraisal Tool (Appendix 8)

Chapter 10 Incident Report

Chapter 11 Injury Report (Appendix 11)

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