To the Parents: SELF HELP 1st 2nd 3rd

The Philippines Early Childhood Development Checklist (form 2) contains 1 Feeds self with finger food (e.g. biscuits, bread) using fingers 1st 2nd 3rd
COGNITIVE DOMAIN
knowledge, skills and attitudes of children 3.1 - 5.11 years old. This may be used as a 2 Feeds self-using spoon with spillage
3 Feeds self-using spoon without spillage 1 Looks at direction of fallen object
guide in knowing your child and consequently give appropriate care and teaching to
4 Feeds self-using fingers with spillage 2 Imitates behavior just seen a few minutes earlier
guide their growth and development.
5 Feeds self-using fingers without spillage 3 Offers object but will not release it
Every page contains different domains of development with their corresponding total 4 Looks for completely hidden object
6 Eats without need for spoon feeding during any meal
scores: 5 Exhibits simple pretend play (red, put doll to sleep)
7 Helps hold cup for drinking
-Gross Motor Domain has 13 items -Express Language Domain has 8 items 6 Matches objects
8 Drinks from cup with spillage
-Fine Motor Domain has 11 Items -Cognitive Domain has 21 items 9 Drinks from cup unassisted 7 Matches 2-3 colors
-Self-help Domain has 27 items -Social-Emotional Domain has 24 items 10 Gets drink for self-unassisted 8 Matches pictures
-Respective Language Domain has 2 items 11 Pours from pitcher without spillage 9 Sorts based on shapes
Each item observed are recorded three times within a year: 1) at the start of the year: 12 Prepares own food/snack 10 Sorts objects based on 2 attributes (e.g., size and color)
2) midyear 3.) at the end of the year. Prepares meals for younger siblings/family members when no adult is 11 Arranges objects according to size from smallest to biggest
13 12 Names 4-6 colors
( √ ) If the child were able to do the task around
( --- ) Response was not display 2 and 3 trials 14 Participates when being dressed (e.g., raises arms or lifts leg) 13 Copies shapes
15 Pulls down gartered short pants 14 Names 3 animals or vegetables when asked
INTERPRETATION OF STANDARD SCORE OR DEVELOPMENT INDEX
16 Removes sando 15 State what common household items are used for
STANDARD SCORE
17 Dresses without assistance except for buttons and tying 16 Can assemble simple puzzles
69 AND BELOW Suggest significant delay in overall development 18 Dresses without assistance including buttons and tying 17 Demonstrates an understanding of opposite by completing a statement
70-79 Suggest slight delay in overall development Informs the adult only after he has already urinated (peed) or moved 18 Points to left and right sides of body (at least 5 body parts)
80-119 Average overall development 19 19 Can state what is silly or wrong with pictures
his bowels (poohed) in his underpants
120-129 Suggests slightly advanced development Informs adult of need to urinate (pee) or move bowels (pooh-pooh) so 20 Matches upper- and lower-case letters
130-above Suggests highly advanced development 20
he can be brought to a designated place 21 Copies shapes (circle, triangle)
Goes to the designated place to urinate (pee) or move bowels and Score
21
(pooh) but sometimes still does this in his underpants
GROSS MOTOR DOMAIN 1st 2nd 3rd Goes to the designated place to urinate or move bowels never does this SOCIAL EMOTIONAL
22 1st 2nd 3rd
in his underpants anymore
Climbs on chair or other elevated piece of furniture like a bed without 23 Wipes/Cleans self after a bowel movement (pooh) 1 Enjoys watching activities of nearby people or animals
1 2 Friendly with strangers but initially may show slight anxiety or shyness
help 24 Participates when bathing (e.g., rubbing arms with soap
2 Walks backwards 3 Plays alone but likes to be near familiar adults or brothers and sisters
25 Washes and dries hands without any help
3 Runs without tripping falling 4 Laughs or squeals aloud in play
26 Washes face without any help
4 Walk down stairs, 2 feet on each step, with one hand held 5 Plays peek-a-boo (bulaga)
27 Bathes without any help
5 Walks upstairs holding handrail, 2 feet on each step 6 Rolls ball interactively with caregiver/examiner
Score
6 Walks upstairs with alternate feet without holding handrail 7 Hugs or cuddles toys
7 Walks downstairs with alternate feet holding handrail 8 Demonstrates respect for elders using terms “po” and “opo”
8 Moves body parts as directed. 9 Shares toys with others
9 Jumps up 1st 2nd 3rd 10 Imitates adult activities (e.g., cooking, washing)
RECEPTIVE LANGUAGE
10 Throws ball overhead with direction 11 Identifies feelings in other
1 Points to family member when asked to do so
11 Hops 1 to 3 steps on preferred foot Appropriately uses cultural gestures of greeting without much
2 Points to 5 body parts on himself when asked to do so 12
12 Jumps and turns prompting (e.g., mano, bless, kiss, etc.)
3 Points to 5 named pictured objects when asked to do so
13 Dances patterns/joins group movement activities 13 Comforts playmates/sibling in distress
Follows one-step instructions that include simple prepositions (e.g., in,
4 14 Persists when faced with a problem or obstacle to his wants
Score on, under, etc.)
5 Follows 2- step instructions that include simple prepositions 15 Helps with family chores (e.g., wiping table, watering plants etc.)
Curious about environment but knows when to stop asking questions of
Score 16
adults
FINE MOTOR DOMAIN 1st 2nd 3rd 17 Waits for turn
18 Asks permission to play with toy being used by another
1 Uses all 5 fingers to get foot/toys placed on flat surface EXPRESSIVE LANGUAGE 1st 2nd 3rd 19 Defends possessions with determination
2 Picks up objects with thumb and index finger 20 Plays organized group games fairly (e.g., does not cheat in order to win)
3 Displays a definite hand preference 1 Uses 5-20 recognizable words Can talk about difficult feelings (e.g., anger, sadness, worry) being
21
4 Puts small objects in/out of containers 2 Uses pronouns (e.g., I, me, ako, akin) experienced
5 Holds crayon with all the fingers of his hand making a fist 3 Uses 2-3 words verb-noun combinations (e.g., hingi gatas) Honors a simple bargain with caregiver (e.g., can play outside only after
22
6 Unscrews lid of container or unwraps food 4 Names objects in pictures cleaning / finishing his room)
7 Scribbles spontaneously 5 Speaks in grammatically correct 2–3-word sentences 23 Watches responsibly over younger siblings/family members
8 Scribbles vertical and horizontal lines 6 Asks “what” and “why” questions Cooperates with adults and peers in group situations to minimize
24
9 Draws circle purposely 7 Asks “who” and “why” questions quarrels and conflicts
10 Draws a human figure (head, eyes, trunk, arms, hands/fingers) Gives account of recent experiences (with prompting in order of Score
8
11 Draws a house using geometric forms occurrence using past tense)
Score Score
ECCD Summary Report
 1st 2nd Assessment 3rd Department of Education
SOCIODEMOGRAPHIC PROFILE
Assessment Assessment Region IX, Zamboanga Peninsula
DOMAINS RS SC RS SC RS SC Division of Zamboanga City
Gross-Motor Child's Name: __________________________________________________
Manicahan District
Fine Motor MANICAHAN POBLACION ELEMENTARY SCHOOL
Self-Help Date of Birth: ___________/__________/_______ Age: ________ Sex: ________
Month Day Year Zamboanga City
Receptive Language _____________________________________
Expressive Language
Cognitive Barangay: ___________________Municipality/City: _____________________
Socio-emotional
Province: ____________________________Region: _______________________
Philippine Early Childhood Care
Sum of Scaled Scores
Standard Scores
*RS – Raw Score

Development Checklist
*SC – Scale Score Child's Handedness: (check appropriate box) right left
INTERPRETATION
Both Not yet established

(ECCD Checklist)
1st Assessment:

Is the child presently studying? (check appropriate box) Yes No

School Year 2022-2023
________________________________
Parent/Guardian’s Signature If yes, write name of child's school / learning center / day care? Yes No
nd _____________________________________________
2 Assessment:

Father's Name: _______________________________Father's Age: _______

________________________________ Father's Occupation: ___________Father's Educational Attainment:_________

Parent/Guardian’s Signature
3rd Assessment: Mother's Name:________________________________ Mother’s Age: _______

Mother’s Occupation: ___________Mother’s Educational Attainment:_________

________________________________
Parent/Guardian’s Signature COMPUTATION OF CHILD'S AGE
Year Month Day Examiner's LRN No:
Name
CERTIFICATE OF COMPLETION
Date Tested
This is to certify that ________________________________ has completed the Kindergarten 1st Child’s Date of
Assessment Birth
Curriculum as prescribed by the Department of Education School year 2022-2023.
Child’s Name: ___________________________________
Noted: Child’s Age
Date Tested _
2nd Child’s Date of
MARY ANN C. BERTO JEANETTE T. GREGORIO,ED.D
Class Adviser School Principal II
Assessment Birth Birth Date: ___________________
Child’s Age
Date Tested
3rd Child’s Date of Birth

ELIGIBILITY TO TRANSFER
Assessment Child’s Age __
Sex: ___ Age: ___ as of ___________________
__ __
Eligible to transfer and admission to __________________________________

MARY ANN C. BERTO JEANETTE T. GREGORIO,ED.D

Class Adviser School Principal II MARY ANN C. BERTO JEANETTE T. GREGORIO, ED.D
Class Adviser School Principal II