It is well established in the literature that the morbidity and mortality rates due to chronic diseases such as cardiovascular disease, cancer, hypertension, and diabetes in the U.S are alarmingly high. Likewise, there is ample data which demonstrates that participating in physical activity can help prevent and control many types of chronic diseases. Though the benefits outweigh the risks of participation in physical activity, the risks must be acknowledged. Published standards and guidelines in the health fitness field have been established to address operational practices of fitness facilities, increase safety of participants and mitigate these risks. The present study was a national investigation conducted to determine adherence to published standards and guidelines for self- and professionally-guided pre-activity health screening procedures (PHSP) across various settings (i.e., Hospital/Clinical, Community, Commercial, Corporate, University, Government). Additionally, this study obtained perspectives from study participants regarding familiarity with, importance of adherence to and legal liability associated with published standards and guidelines. As the American College of Sports Medicine (ACSM) is considered the gold standard in health and fitness, only ACSM's published standards and guidelines, specifically those related to pre-activity health screening, were included in the present study. A survey instrument was developed and validated to obtain the data for this study. The link for the web-based survey was sent from the ACSM's Certification Department to all ACSM Health Fitness Specialists (HFS) who lived in the US (n=9,433); a total of 1,246 (13.2%) responded to the survey. The survey instrument consisted of 54 questions including 14 participant related (i.e., Q1, Q3, Q34-Q45), 32 facility related (i.e., Q2, Q4-Q33, Q46), seven demographic related (Q47-Q53), and one open-ended question (Q54). Exclusion criteria removed any HFS who was not currently working part- or full-time in a fitness facility, which left 677 usable responses for data analysis. Special measures were taken to remove duplicate responses for any given facility which resulted in a lower number of usable responses (n=656) for those 32 questions. As hypothesized, the Hospital/Clinical setting had significantly (p<.006) higher percentages of fitness facilities (93%) which require new participants to complete a pre-activity screening device than all other settings (i.e., University (56%), Community (54%), Commercial(40%), and Government (67%)). Additionally, the Hospital/Clinical setting was also found to be significantly higher than Corporate relative to this same variable. Regarding the second research hypothesis, the Corporate setting was found to have significantly (p<.006) higher percentages (78%) of fitness facilities which require new participants to complete a pre-activity screening device than the Community setting. Twenty-six percent of respondents indicated they their facility conducted self-guided, 43% professionally guided, and 31% offered both self- and professionally-guided PHSP. High percentages of fitness facilities (73%) required new participants to complete a pre-activity screening device with 47% and 87% of these facilities requiring medical clearance for at-risk new participants for self- and professionally-guided screening procedures, respectively. At-risk was defined in the study as someone with known disease (e.g., cardiac, pulmonary or metabolic) or with signs/symptoms and/or risk factors associated with cardiac, pulmonary, or metabolic disease. Also, participants with other medical conditions (e.g., pregnancy, orthopedic injury) may be considered at- risk. The majority (86%) of facilities offered personal training and nearly all of these (99.6%) required clients of personal trainers to complete a pre-activity screening device. Additionally, 84% of these facilities required medical clearance for at-risk clients. Data regarding other aspects of PHSP for facilities were also obtained such as frequency of completion for participants, privacy, confidentiality, and security of information obtained, participant refusal to complete, and waivers for guests. Regarding their familiarity, 69% of respondents indicated that they were very familiar with the ACSM's Guidelines for Exercise Testing and Prescription (ACSM's GETP); however only 52% indicated they used the ACSM's GETP for development and implementation of their facility's PHSP. Of these facilities, the results regarding the inclusion of the GETP criteria on their screening device were: (a) 96%, 91%, 87% for known CV, pulmonary and metabolic disease, respectively, (b) 44-95% for each of the nine signs/symptoms with dizziness/syncope the highest (95%) and intermittent claudication the lowest (44%), and (c) 64%- 99% for each of the nine CV risk factors with smoking the highest (99%) and high-density lipoprotein the lowest (64%). Although 52% of respondents reported more than adequate academic preparation, 70% reported being very confident in conducting professionally-guided pre-activity health screening procedures and that adherence to published standards and guidelines was very important. However, only 28% of respondents reported more than adequate academic preparation regarding legal implications involving PHSP. Other data from the HFSs regarding PHSP were also obtained such as their perspectives of the importance to management to adhere to and familiarity with published standards and guidelines as well as their knowledge of legal issues related to PHSP. In the open-ended question, respondents provided comments and challenges (n=509) that they encountered while conducting PHSP. These data were analyzed, coded and then categorized into three major themes: 1) medical clearance related issues, 2) administrative/procedural related issues, 3) member related issues. Compared to previous research, adherence to published standards and guidelines, as evidenced by the percentage of facilities which require new participants and clients of personal trainers to complete a pre-activity screening device, seems to be generally increasing. Additionally, relative to the requirement of medical clearance for personal training clients also seems to demonstrate an upward trend. However, the requirement of medical clearance for at-risk new participants remains about the same as previous studies (ranging from 49%-82% of the facilities) and the current study (47% for self-guided and 87% for professionally-guided). For facilities that were not conducting PHSP (27%), the major reasons why were reinforced by the comments to the open-ended question and were similar to those found in a previous study that investigated the same. The findings from this study indicated that there are areas that may need to be addressed within the profession to help increase adherence to published standards and guidelines especially in Community, Commercial, University, and Government settings. For example, these facilities might need a more simplified approach and additional guidance from the ACSM for more effectively and efficiently conducting PHSP. Additionally, academic programs could contribute by more comprehensively integrating PHSP into courses and practical learning opportunities for students. Given the importance of conducting PHSP, future research in PHSP focused on issues specific to individual settings may help establish the framework and provide direction for stakeholders to address this relevant issue in the field.