Learning Task 1: Medical History Questionnaire
Name: ________________________________________ Date: __________________________
Section: _______________________________________
Questions YES NO
Family History
Have any immediate family members had a:
Heart attack
Heart surgery
Coronary stent
Cardiac catheterization
Congenital heart defect
Stroke
Other chronic diseases
Personal History
Have you ever had:
High blood pressure
High cholesterol
Diabetes
Any heart problems
Disease of arteries
Thyroid disease
Lung disease
Asthma
Kidney disease
Hepatitis
Other chronic diseases
Symptoms
Have you ever had:
Chest pain
Shortness of breath
Heart palpitation
Skipped heartbeats
Heart murmur
Intermittent leg pain
Dizziness or fainting
Fatigue – usual activities
Snoring
Back pain
Reflection:
Question: Why is it important to be honest in consulting one’s medical history?
______________________________________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________________________
Note: Before participating in any recreational activity, it is important to fill out a Medical History Questionnaire. This helps you and your
instructors understand your current health condition and any risks that may affect your safety. By sharing information such as past injuries,
allergies, medical conditions, or medicines you are taking, you allow teachers and activity leaders to plan activities that are safe and suitable
for you.
Completing this questionnaire ensures that you can enjoy recreational activities with confidence, reduces the chance of accidents or health
problems, and helps everyone respond quickly in case of emergencies. Being honest and accurate protects not only your health but also the
wellbeing of the whole group.
Excelle
points
Performance Task : Physical Test
Direction: Perform the different exercises and assess your physical abilities. Follow the scoring system on the template. Please include 4-6
pictures of yourself performing the exercises at home or in any safe location. Make sure the photos clearly show proper form and safe
execution of the activity. Kindly wear your P.E. attire while performing the exercises.
Exercises Excellen Good Poor 2 points Score
t5 3 points
points
Basic Plank position Held position for 60 seconds Held position for 30 seconds Held position for 15 seconds
Push-up Perform 20 times with correct Perform 15 times with correct Perform 10 times with correct execution
execution execution
Overhead Squat Perform 20 sets with correct Perform 15 sets with correct Perform 10 sets with correct execution
execution execution
Stork Stand Test Held position for 60 seconds Held position for 30 seconds Held position for 15 seconds
Self-myofascial Release Can perform ALL exercises with the Can perform HALF exercises with the Can perform AT LEAST TWO exercises with
a. Calves correct execution correct execution the correct execution
https://
[Link]/
watch?v=C7qnbmpLNGI
b. Piriformis
https://
[Link]/
watch?v=mT-3b4rgRzg
c. Quadriceps
https://
[Link]/
watch?v=k7Ot1aGjbq0
Static Stretching Can perform ALL exercises with the Can perform HALF exercises with the Can perform AT LEAST TWO exercises with
a. Side squat correct execution correct execution the correct execution
https://
[Link]/
watch?v=4Oq6WXBmsUg
b. Hamstring stretch
https://
[Link]/
watch?v=T_l0AyZywjU
c. Shoulder stretch
Dynamic Stretching Can perform ALL exercises with the Can perform HALF exercises with the Can perform AT LEAST TWO exercises with
a. Knee hug and calf raise correct execution correct execution the correct execution
https://
[Link]/
watch?v=b3klAXTFC3A
b. Lunge and twist
https://
[Link]/
watch?v=3hQEQIWgF9E
TOTAL
Note: You may click the link to guide you in performing the exercises correctly. If you are not feeling well, experiencing discomfort, or have been advised not to
participate in physical activities, please avoid doing the exercises for your safety. Always listen to your body and prioritize your health.
PERFORMANCE TASK: Slogan Making
Direction: Create a slogan that summarizes your understanding of the lesson Health and Risk Assessment in Recreational Activity. Write your
slogan neatly on a long bond paper. Be creative and make sure your message clearly promotes safety, health awareness, and responsible
participation in recreational activities.
Scor
Criteria Description
e
The slogan clearly reflects concepts from the lesson such as health awareness, safety practices, identifying risks, and
Content Accuracy 1–5
responsible participation in recreational activities. Shows correct understanding of key ideas.
The slogan communicates the intended message in a clear, concise, and meaningful way. Easy to understand and
Clarity of Message 1–5
directly connected to the topic.
Creativity & Originality The slogan is unique, creative, and engaging. Shows originality in wording, style, or approach. 1–5
Relevance to Health & The slogan emphasizes safety, prevention, preparation, or proper risk assessment in recreational activities. Strong
1–5
Risk Assessment alignment with the lesson.
Visual Impact Visual presentation enhances the message. Use of color, layout, and design supports clarity and catches attention. 1–5
Total Score: 25 points