Form Phs 7044 PDF Details

Maintaining a high standard of physical readiness is a critical requirement for officers in the U.S. Public Health Service Commissioned Corps, as outlined in the Phs 7044 form. This comprehensive document serves as a tool for assessing and reporting an officer's physical fitness in line with the Department of Health and Human Services' guidelines. Officers are required to complete various sections of this report to demonstrate their compliance with the physical readiness standards. These sections include personal identification details, body mass index (BMI) measurements, body fat content, and the results of an annual physical fitness test. The fitness test encompasses several activities designed to evaluate cardiovascular health, core muscle strength, and upper body strength. The completion and submission of this form are critical steps in fulfilling the regulations set forth under Subchapter CC26.1, Instruction 8, of the Commissioned Corps Personnel Manual. Moreover, this procedure not only affects an officer's readiness status but can also have implications for their promotion potential, emphasizing the significance of accurate and timely submissions. The submission process is dual: officers must send the original signed report to the Office of Commissioned Corps Support Services and also enter their results online, ensuring a thorough and verifiable record of their physical readiness is maintained.

QuestionAnswer
Form NameForm Phs 7044
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesCC26, phs 7044 1 fillable, phs 7044 1, seq

Form Preview Example

Department of Health and Human Services

U.S. Public Health Service Commissioned Corps

PHYSICAL READINESS STANDARDS REPORT

SECTION I

OFFICER’S NAME (Please print: Last, First, Middle Initial)

 

PHS SERIAL NUMBER

 

RANK / GRADE

 

 

 

 

 

 

 

 

 

 

 

OFFICER’S SIGNATURE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

MALE

FEMALE

 

 

 

 

 

 

 

 

 

 

SECTION II

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

BODY MASS INDEX (BMI)

 

Date Recorded

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Height in Inches

 

Weight in Pounds

BMI

 

 

 

 

 

 

 

 

 

 

 

 

NOTE: Intermediate and Advanced Level only.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

BODY FAT

 

Date Measured

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Height in Inches

 

Neck Circumference In Inches

Body Fat

 

 

 

 

 

 

 

 

 

 

 

 

Waist at Narrowest Point in Inches

 

Hips at Widest Point in Inches

 

 

 

 

 

 

 

(Female Officers only)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NOTE: Intermediate and Advanced Level only.

I certify that the above records are true and correct.

MEASURING OFFICIAL (Please print: Last, First, Middle Initial)

PHS SERIAL NUMBER

 

 

MEASURING OFFICIAL’S SIGNATURE

DATE

 

 

SECTION III

ANNUAL PHYSICAL FITNESS TEST

CATEGORY A - CARDIOVASCULAR HEALTH

Check box and complete one of the following:

1.5 Mile Run

 

(time recorded to nearest second)

450 Meter Swim

 

(time recorded to nearest second)

500 Yard Swim

 

(time recorded to nearest second)

CATEGORY B - CORE MUSCLE STRENGTH Check box and complete either one of the following:

Sit-Ups

 

(record number of sit-ups

 

 

in 2 minutes)

Side-Bridge

 

(record time in seconds

 

 

that position is held)

CATEGORY C - UPPER BODY STRENGTH -- Complete the following:

Push-Ups

 

(record number of push-ups in 2 minutes)

I certify that the above records are true and correct.

TESTING OFFICIAL (Please print: Last, First, Middle Initial)

PHS SERIAL NUMBER

TESTING OFFICIAL’S SIGNATURE

DATE TESTED

Submit completed form (with original signatures) to:

Office of Commissioned Corps Support Services

ATTN: Medical Affairs Branch

5600 Fishers Lane, Room 4C-04

Rockville, MD 20857-0001

Officers must also enter results at:

http://ccrf.hhs.gov

PHS-7044 (8/04) (PAGE 1)

INSTRUCTIONS TO

PHYSICAL READINESS STANDARDS REPORT,

FORM PHS-7044

All active-duty Public Health Service Commissioned Corps officers are required to meet specific standards for the Basic level of force readiness by 1 May 2005, and are required to be screened annually. This report is part of the procedure for determining compliance with Subchapter CC26.1, INSTRUCTION 8, "PHS Readiness Standards," of the Commissioned Corps Personnel Manual.

The officer being measured/tested must complete and sign Section I of this report. The Measuring Official/Testing Official must complete and certify Sections II and III. The officer must submit the completed report (with original signatures) to the address at the bottom of the report and enter results at http://ccrf.hhs.gov .

PRIVACY ACT STATEMENT

AUTHORITY: 42 U.S.C. 202 et seq, E.O. 9397, and Subchapter CC26.1, INSTRUCTION 8, of the Commissioned Corps Personnel Manual.

PRINCIPAL PURPOSE(S): To obtain data necessary for determining officer’s level of Force Readiness.

ROUTINE USE(S): None.

DISCLOSURE: Voluntary; however, refusal to submit information will affect the determination of officer’s level of Force Readiness and may impact the officer’s promotion potential. Officer’s PHS serial number is required for identification purposes.

SYSTEM NOTICE FOR RECORDS SYSTEM: The information provided on this report will become part of record system 09-40-0002, "PHS Commissioned Corps Medical Records," HHS/PSC/HRS.

PHS-7044 (8/04) (PAGE 2)

INSTRUCTIONS