MAINE DEPARTMENT OF CORRECTIONS
PHYSICAL FITNESS TEST APPLICATION / RESULTS
Name:
Please Print (Last) (First) (Middle)
Mailing
Address:
(Street / P.O. Box) (City / Town) (State) (Zip)
Date of Birth: / / Email address__________________________________ Phone:
I am taking this test voluntarily. I understand the physical requirements of this test and know of no reason why I cannot
safely complete all portions of the test including the one mile run/brisk walk, one minute sit up test, and the maximum
push-up test. I agree to indemnify and hold harmless the State of Maine, the Department of Corrections and their
respective officers, employees and agents from any claim, damage, injury or illness, of whatever kind or nature, resulting
from the administration of the test and my taking of the test.
I, __________________________, authorize the release of my Physical Fitness scores by Maine DOC to
all Maine DOC facilities.
Overall Test Performance (circle one pass/fail)
Push-up Test _____ Repetitions
_____ Points received Points
Sit-up Test _____ Repetitions
_____ Points received Points
Step Test 96 Steps
96 steps in 60 seconds Pass 10 pts. / Fail Points
140lb. dummy drag 100 ft.
Within 90 seconds Pass 10 pts. / Fail Points
Carry Fire Extinguisher 100 ft.
While following instructions Pass 10 pts. / Fail Points
1 Mile Run/briskwalk Test _____ Time
_____ Points received Points
Total Points
Minimum of 120 needed to pass
Participant Signature: ____ Date:
By signing, the evaluator attests that all information contained in this form is true and accurate.
Fitness Tester Name: _________ _______Signed: _____ ______ Date:
1
Physical Agility Test Requirements:
This is a 6-event test. Each event is scored according to the scoring matrix. The 6-event scores are totaled to
reach the final score. You can score more points by doing higher number of repetitions therefore creating a
higher score. If one doesn’t score well in one event, they can make it up in another event. A minimum score of
120 points will be considered a passing score for the PAT test.
Event #1 – Push Ups (one minute) Event #2 – Sit Ups (one minute)
# of repetitions 3.5 pts/rep # of repetitions 3.5 pts/rep
1 3.5 1 3.5
2 7 2 7
3 10.5 3 10.5
4 14 4 14
5 17.5 5 17.5
6 21 6 21
7 24.5 7 24.5
8 28 8 28
9 31.5 9 31.5
10 35 10 35
11 38.5 11 38.5
12 42 12 42
13 45.5 13 45.5
14 49 14 49
15 52.5 15 52.5
16 56 16 56
17 59.5 17 59.5
18 63 18 (max) 63
19 66.5
20 70
21 73.5
22 77
23 (max) 80.5
Event #3 – Steps Test
96 steps in 60 seconds Pass (10pts.) / Fail
Event #4 – 140lb Dummy Drag
Drag the Dummy 100ft to safety within 90 seconds Pass (10pts.) / Fail
Event #5 – Fire Extinguisher
Carry extinguisher for 100ft. while following instructions Pass (10pts.) / Fail
Fire Extinguisher instructions:
Pick up fire extinguisher. Stop at cone, set fire extinguisher down. Yell for help. Pick up fire extinguisher and
continue to last cone. Set fire extinguisher down.
2
Event #6 – 1 Mile Run/brisk walk
Time Points Time Points Time Points
17:44 .5 17:12 16.5 16:38 32.5
17:43 1 17:11 17 16:37 33
17:42 1.5 17:10 17.5 16:36 33.5
17:41 2 17:09 18 16:35 34
17:40 2.5 17:08 18.5 16:34 34.5
17:39 3 17:07 19 16:33 35
17:38 3.5 17:06 19.5 16:32 35.5
17:37 4 17:05 20 16:31 36
17:36 4.5 17:04 20.5 16:30 36.5
17:35 5 17:03 21 16:29 37
17:34 5.5 17:02 21.5 16:28 37.5
17:33 6 17:01 22 16:27 38
17:32 6.5 17:00 22.5 16:26 38.5
17:31 7 16:59 23 16:25 39
17:30 7.5 16:58 23.5 16:24 39.5
17:29 8 16:57 24 16:23 40
17:28 8.5 16:56 24.5 16:22 40.5
17:27 9 16:55 25 16:21 41
17:26 9.5 16:54 25.5 16:20 41.5
17:25 10 16:53 26 16:19 42
17:24 10.5 16:52 26.5 16:18 42.5
17:23 11 16:51 27 16:17 43
17:22 11.5 16:50 27.5 16:16 43.5
17:21 12 16:49 28 16:15 44
17:20 12.5 16:48 28.5 16:14 44.5
17:19 13 16:45 29 16:13 45
17:18 13.5 16:44 29.5 16:12 45.5
17:17 14 16:43 30 16:11 46
17:16 14.5 16:42 30.5 16:10 46.5
17:15 15 16:41 31 16:09 47
17:14 15.5 16:40 31.5 16:08 47.5
17:13 16 16:39 32 16:07 48
