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Health Screening

Iron Jungle adult pre-exercise screening tool

You must complete this health screen form before your first session or download here and complete manually.

Name

Date of Birth

1. Has your doctor ever told you that you have a heart condition or have you ever suffered a stroke?

YesNo

2. Do you ever experience unexplained pains in your chest at rest or during physical activity?

YesNo

3. Do you ever feel faint or have spells of dizziness during physical activity/exercise that causes you to lose balance?

YesNo

4. Have you had an asthma attack requiring immediate medical attention at any time?

YesNo

5. If you have diabetes (type 1 or 2), have you had trouble controlling your blood glucose in the last 3 months?

YesNo

6. Do you have any diagnosed muscle, bone or joint problems that you have been told could be made worse by participating in physical activity/exercise?

YesNo

7. Do you have any other medical condition(s) that may make it dangerous for you to participate in physical activity/exercise?

YesNo

IF YOU ANSWERED "YES" to any of the 7 questions, please seek guidance from your GP or appropriate allied health Professional prior to undertaking physical activity/exercise.

IF YOU ANSWERED "NO" to all 7 questions, and you have no other concerns about your health, you may proceed to undertake light-moderate physical activity/exercise.

I believe to the best of my knowledge, all the information I have supplied within this tool is correct.

This screening tool does not provide advice on particular matter, nor does it substitute for advice from an appropriately qualified medical professional. No warranty of safety should result from its use. The screening system in no way guarantees against injury or death. Iron Jungle can accept no responsibility or liability whatsoever for any loss, damage or injury that may arise from any person acting on statement or information contained in this tool.