Child’s Name: MARCK KAL G.

ANGKATAN Region XII

SOCIO- EMOTIONAL BoSY EoSY
Sex: Male Date of Birth: 09-26-2014 Division of Sultan Kudarat
DOMAIN Commen Address: KALAWAG III ISULAN SULTAN KUDARAT
P ts
P Comments East Isulan District
1
Enjoys watching activities of people or nearby Child’s Handedness: (Check Appropriate Box) KALAWAG III ELEMENTARY SCHOOL
animals.
Right Left Not yet established (209001)
Friendly w/ strangers but may initially show slight
2
shyness. S.Y. 2020-2021
Father’s Name: CELSO ANGKATAN Age: ____
Plays alone but likes to be near to familiar adults or
3
brother and sister. Occupation: BAKER
4 Laughs or squeals aloud in play. Educational Attainment: ______________________
5 Plays peek-a-boo (bulaga). Mother’s Name: OLIVIA ANGKATAN Age: ____
6 Rolls ball interactively with caregiver/ examiner.
Occupation: HOUSEKEPEER Early Childhood Care and
Educational Attainment: _______________________ Development (ECCD)
7 Hugs or cuddles toys.
Demonstrates respect for elders using “po” and SUMMARY OF ASSESMENT
8
“opo”.

9
Shares toys with others familiar adults or brother and Checklist
sister.
BoSY EoSY
10 Imitates adults activities (e.g. cooking, washing) Date Assessed
Pupil’s Age
11 Identifies feelings of others. Domains RS SC RS SC

Appropriately uses cultural gestures of greetings Gross-Motor

12
without much prompting( e.g. mano/bless, kiss, etc.) Fine Motor
13 Comforts playmates/siblings in distress. Self-Help
Receptive Language
Persists when faced with a problem or obstacle to his
14 Expressive Language
wants.
Cognitive Name: MARCK KEL G. ANGKATAN
Helps with family chores(e.g. wiping tables, watering
15
plants) Socio-emotional Sex: Male
Curious about environment but knows when to stop Sum of Scaled Scores Birthday: 09-26-2014
16
asking questions to adult.
Standard Scores LRN: 2 0 9 0 0 1
-
17 Waits for turns.

18
Asks permission to play with toys being used by INTERPRETATION
others.
To the Parents: 2 0 0 0 0 3
The Philippine Early Childhood Care and Development Checklist
19 Defends possessions with determination.
(Form 2) contains knowledge, skills, and attitudes of children 3 – 5.11 years
Plays organized group games fairly(e.g. does not BoSY: old. This may be used as a guide in knowing your child and consequently give
20 appropriate care and teaching to guide their growth and development.
cheat in order to win).
Can talk about difficult feelings (e.g. anger, sadness,
21
worry) he experience. PARENT’S SIGNATURE
Honors a simple bargain with caregiver (e.g., can
22
play outside only after cleaning/fixing his room) EoSY: SHYLA MAY D. TAN
Watches responsibly over younger siblings/family
23 Teacher
members.
GEORGE S. MOYET
Cooperates with adults and peers in group situations Principal I
24
to minimize quarrels and conflicts.
PARENT’S SIGNATURE
Total Score GROSS MOTOR DOMAIN BoSY EoSY
P Comment P Commen
Republic of the Philippines s ts
Climbs on chair or elevated piece of furniture like a
PUPIL’S SOCIO-DEMOGRAPHIC PROFILE Department of Education 1
 bed without help 10 Gets drink for self-unassisted. COGNITIVE DOMAIN BoSY EoSY
2 Walks backward. 11 Pours from pitcher without spillage. P Comments P Commen
3 Runs without tripping or falling. 12 Prepares own food/snacks. ts
Walks down stairs, 2 feet on each step, with one 1 Looks at direction of fallen object
4 13 Prepares meals for younger siblings/ family
hand held. 2 Looks for partially hidden object
members when no adult is around.
5 Walks upstairs holding handrail, 2 feet on each step. Participates when being dressed. 3 Imitates behavior just seen a few minutes earlier
14
6 Walks upstairs with alternate feet without holding Pulls down gartered short pants. 4 Offers object but will not release it
15
handrail.
16 Removes sando. 5 Looks for completely hidden object
7 Walks downstairs with alternate feet without holding
handrail. Dresses without assistance except buttons and 6 Exhibits simple pretend play (feed, put doll to sleep)
17
8 Moves body part as directed. tying. 7 Matches objects
Jumps up Dresses without assistance including buttons
9 18 8 Matches 2 – 3 colors
and tying.
1 Throws ball overhead with direction. Informs the adult only after he has already 9 Matches pictures
0 19 urinated (peed) or moved his bowels (pooped) 10 Sorts objects based on 2 attributes (e.g., size and
1 Hops 1 to 3 steps on preferred foot. in his underpants. color)
1 Informs adult of need to urinate (pee) or move 11 Sorts objects based on 2 attributes (e.g.,shape and
20 bowels (poop) so he can be brought to a color)
1 Jumps and turns.
designated place (e.g. comfort room) 12 Arranges objects according to size from smallest to
2 Goes to the designated place to urinate (pee) or biggest
1 Dances patterns/joins group movement activities. 21 move bowels (poop) but sometimes still does 13 Names 4 – 6 colors
3 this in his underpants.
Goes to the designated place to urinate (pee) or 14 Copies shapes
Total Score
22 move bowels (poop) and never does this in his 15 Names 3 animals or vegetables when asked
underpants anymore 16 States what common household items are used for
Wipes/Cleans self after a bowel movement
23
BoSY EoSY (poop) 17 Can assemble simple puzzles
FINE MOTOR DOMAIN Comment Commen Participates when bathing (e.g. rubbing arms 18 Demonstrates an understanding of opposites by
P s
P ts
24
with soap) completing a statement (e.g., Ang aso ay malaki,
Uses all five fingers to get food/toys placed on flat surface. 25 Washes and dries hands without any help. ang daga ay _____”)
1
Picks up objects with thumb and index finger. 26 Washes face without any help. 19 Points to left and right sides of body
2
Displays a definite hand preference.
27 Bathes without any help. 20 Can state what is silly or wrong with pictures (e.g.
3
Ano ang mali sa larawang ito?)
Puts small objects in/out of containers. Total Score Matches upper and lower case letters
4 2
Holds crayon with all fingers of his hand making a fist (i.e. 1
5 palmar grasp) Total Score
6 Unscrews lid of container or unwraps food. BoSY EoSY
7 Scribbles spontaneously. RECEPTIVE LANGUAGE P Comment P Comment
Scribbles vertical and horizontal lines. s s
8 P- Present
1 Points to family member when asked to do so
9 Draws circle purposely.
2 Points to 5 body parts on himself when asked to do so RS – Raw Score
Draws a human figure (head, eyes, trunk, arms,
10 3 Points to 5 named pictured objects when asked to do so
hands/fingers) SC – Scaled
11 Draws a house using geometric forms. 4 Follows one-step instructions that include simple
prepositions (e.g., in, on, under, etc.) Score
Total Score Follows 2-step instructions that include simple
5
prepositions
Total Score

SELF HELP DOMAIN BoSY EoSY

P Comments P Comments BoSY EoSY
1 Feeds self with finger foods (e.g. biscuits, EXPRESSIVE LANGUAGE P Comment P Comments
bread) using fingers. s
2 Feeds self using fingers with spillage. 1 Uses 5-20 recognizable words
2 Uses pronouns (e.g. I, me, ako, akin)
3 Feeds self using spoon with spillage.
3 Uses 2-3 words verb-noun combinations (e.g. hingi
4 Feeds self using fingers without spillage. gatas)
5 Feeds self using spoon without spillage. 4 Names objects in pictures
6 Eats without need for spoon feeding during any 5 Speaks in grammatically correct 2-3 word sentences
meal. 6 Asks “what” questions
7 Helps hold cup for drinking. 7 Asks “who”' and “why” questions
8 Drinks from cup with spillage. 8 Gives account of recent experiences (with prompting)
in order of occurrence using past tense
9 Drinks from cup unassisted. Total Score