Contents        Previous (Appendix 4.1)        Next (Part IV)


Appendix 5.1 Example of the Anthropometry Data Recording Form


Data recording form:

Participant's identification code |__||__||__||__||__||__|

Weight measurement:

Person measuring weight (identification code) |__||__|
Date (ddmmyyyy) |__||__|.|__||__|.|__||__||__||__|
Weight (kg) |__||__||__|.|__|
If participant is not weighed, give reason:
1 = pregnant women 
2 = wheelchair bound 
3 = unsteady stance 
4 = weight exceeds upper limit of scale (upper limit of the scale: |__||__||__| kg)
5 = refused
6 = other, specify:
|__|
Describe special conditions, if any:

 

Height measurement:

Person measuring height (identification code) |__||__|
Date (ddmmyyyy) |__||__|.|__||__|.|__||__||__||__|
Height (cm) |__||__||__|.|__|
If no height measurement was made, give reason:
1 = hairstyle, head gear
2 = wheelchair bound 
3 = unsteady stance 
4 = height exceeds upper limit of stadiometer (upper limit of the stadiometer: |__||__||__| cm )
5 = refused
6 = other, specify:
|__|
Describe special conditions, if any:

 

Waist and hip circumference measurement:

Person measuring waist and hip (identification code) |__||__|
Date (ddmmyyyy) |__||__|.|__||__|.|__||__||__||__|
Waist circumference (cm) |__||__||__|.|__|
Hip circumference (cm) |__||__||__|.|__|
If no waist/hip circumference measurement was made, give reason:
1 = pregnant woman
2 = wheelchair bound 
3 = unsteady stance 
4 = circumference exceeds length of tape (length of tape: |__||__||__| cm )
5 = refused
6 = other, specify:
|__|
Describe special conditions, if any:

Contents        Previous (Appendix 4.1)        Next (Part IV)

Valid HTML 4.01!