Aim: To identify individuals with known disease, and/or signs or symptoms of disease, who may be at a higher risk of an
adverse event due to exercise. An adverse event refers to an unexpected event that occurs as a consequence of an
exercise session, resulting in ill health, physical harm or death to an individual.
This stage may be self-administered and self-evaluated by the client. Please complete the questions below and refer to
the figures on page 2. Should you have any questions about the screening form please contact your exercise professional
for clarification
IF YOU ANSWERED ‘YES’ to any of the 6 questions, please seek guidance from an appropriate
allied health professional or medical practitioner prior to undertaking exercise.
IF YOU ANSWERED ‘NO’ to all of the 6 questions, please proceed to question 7 and calculate your typical weighted physical activity/
exercise per week.
7. Describe your current physical activity/exercise levels in a typical week
by stating the frequency and duration at the different intensities.
For intensity guidelines consult figure 2.