Pre-Exercise Screening and Consent Form
v2.1
Purpose. This form is completed by every new member and program participant before their first session to identify health risks, obtain consent and decide whether medical clearance is needed before exercise.
1.When to use this form
Every new member, personal training client, group program participant and aquatic exercise participant completes this form before their first session. It is completed again when a member's health changes or every twelve months for members in special population programs.
2.Stage one questions
The stage one questions follow the adult pre-exercise screening system. A yes answer to any question means the instructor will refer the member to a medical practitioner before they begin exercise beyond light activity. The instructor reviews every answer with the member.
3.Stage two measures
With the member's consent the instructor records resting blood pressure, resting heart rate, height, weight and waist measurement, and compares them with the guideline ranges. Measures outside the ranges are discussed with the member and lead to referral where the guideline requires.
4.Consent and privacy
The member consents to exercise on the basis of the screening, to the collection of health information for the purpose of program design and to the emergency contact being called in an emergency. Health information is held in the member and client register under the Privacy Act 1988 and released only to the instructor and, with consent, the member's medical practitioner.
5.Members under eighteen
A parent or guardian completes and signs the form with the adolescent member and agrees to the supervision arrangements for their program.