Army Physical Fitness Test (APFT) Failure Counseling Statement Example in MS Word and Pure-edge

Soldiers fail the Army Physical Fitness Test (APFT) for various reasons which range from poor eating habits and training to just plain
lack of discipline. When a Soldier fails the APFT he or she must be counseled on a DA Form 4856, FLAGGED, Given Extra PT and
schedule a date for a "Not for record" APFT before a new record test is given but be sure to check your Unit SOP and Command
Policy Letters. Here is an Example Counseling Statement for you to use as a guide while writing your DA 4856.

Download this Counseling Statement in
MS Word or Download a Blank DA Form 4856 -- See Also: AR 350-1 and FM 7-22
APFT Army Counseling Statement Example
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PART II - BACKGROUND INFORMATION
Purpose of Counseling

To Discuss:

Soldier’s Army Physical Fitness Test Failure (APFT) IAW Army Regulation 350-1
Best ways in which to correct substandard performance
Consequences of consecutive Record APFT failures
PART III - SUMMARY OF COUNSELING
Complete this section during or immediately subsequent to counseling.
Key Points of Discussion:

Results of APFT:

• On {DATE} you were administered a record APFT.  You achieved the following scores:

Pushups (reps/score): ____/____        Sit-ups (reps/score): ____/____        2-mile run (time/score): ____/____

• You failed to achieve a passing score in the Push-up Event and missed by # points.

Actions:
As a result or your performance I am Recommending that the following actions be taken (indicated by check mark):

_____You be enrolled in the special populations PT Program beginning {DATE}, located at {LOCATION}

_____You be removed from participating in unit sports teams

_____ In accordance with AR 350-1 you will be flagged under AR 600-8-2 until you pass the APFT.  This flag will stop all favorable
actions (to include Tuition Assistance), and will only be removed when you pass the APFT.

_____You be barred from reenlistment      

In addition, I am informing you that you have 3 months (90 days following the initial APFT failure) in which to retake and pass your
APFT.  When you feel you are ready to re-take the APFT, you will require approval from the unit commander IAW AR 350-1.  Should
you fail two consecutive “For Record” APFTs you may be separated from the military.      

Soldier gave the following reasons for poor performance during this APFT:
OTHER INSTRUCTIONS
This form will be destroyed upon: reassignment (other than rehabilitative transfers), separation at ETS, or upon retirement. For separation requirements
and notification of loss of benefits/consequences see local directives and AR 635-200.