SUMMARY

Domains of Development First Second Remarks Republic of the Philippines

Department of Education
Semester Semester
Region IX, Zamboanga Peninsula
Gross Motor Domain(SS) DIVISION OF ZAMBOANGA SIBUGAY
Fine Motor Domain(SS) PAYAO District
Self-Help Domain(SS) BALUNGISAN ELEMENTARY SCHOOL

Receptive Language Domain(SS)

Expressive Language Domain(SS)

Philippine Early Childhood

Cognitive Domain (SS)
Socio-Emotional Domain (SS)
Overall Interpretation(SSS)
SID-(Significant Delay in Devt.) SLD(Slight delayed in Devt) AD- (Average Development) Development Checklist
SAD(Slightly Advanced Devt.) HAD (Highly Advanced Devt)

Pupil’s Attendance Form 2

Month
No. of
June July Aug Sept Oct Nov Dec Jan Feb Mar Total (4.0 – 5.11 years old)
Days
Present
Absent
Tardy
Certified:

GEMELYN S. CORTES
(Teacher)
LUZVIMINDA C. AMAGA
Child’s Name: ______________________________________________
(Principal/Head Teacher/TIC)
Conforme:
Birthdate: ___________ Age: ________ as of October, 2013 Sex: _____

Parents’ Signature: _________________________________________

(First Semester)

Parents’ Signature: _________________________________________

(Second Semester)
Child’s Name: ______________________________________________________ SOCIAL - P O R COMMENTS P O R COMMENTS P O R COMMENTS
EMOTIONAL
Province: Zambo. Sib. Municipality/City: Payao Barangay: Balungisan DOMAIN
15. Helps with family
chores (e.g., wiping
Sex: _______ Male Handedness: __________ Right
tables, watering
plants, etc.)
_______ Female __________ Left 16. Curious about
environment but
To the Parents: knows when to stop
The Philippine Early Childhood Development Checklist (Form 2) contains knowledge, asking questions of
skills and attitudes of children 4.00 – 5.11 years old. This may be used as a guide in adults
knowing your child and consequently give appropriate care and teaching to guide 17. Waits for turn
18. Asks permission to
their growth and development. play with toy being
Content: used by another
Every page contains different domains of development with their corresponding total 19. Defends possessions
scores: with determination
20. Plays organized
group games fairly (e.
- Gross Motor Domain has 13 items - Expressive Language Domain has 8 g., does not cheat in
items order to win)
- Fine Motor Domain has 11 items - Cognitive Domain has 21 items 21. Can talk about
- Self-help Domain has 27 items - Social-Emotional Domain has 24 items difficult feelings (e.g.,
- Receptive Language Domain has 5 anger, sadness,
items worry) he
experiences.
22. Honors a simple
bargain with
Each item observed are recorded three times within a year: 1) at the start of the caregiver (e.g., can
year, 2) at the middle of the year, and 3) at the end of the year. play outside only
after
cleaning/finishing his
Columns: room)
23. Watches responsibly
P – Present or the child can do the task over younger
siblings/family
O – Observed or the child was observed doing the task members
R – Report given by the parents/caregiver about the skill 24. Cooperates with
adults and peers in
Score: group situations to
minimize quarrels
and conflicts
(√ ) Present or child is able to do the task TOTAL SCORE:
( - ) Skill is not present or child does not respond
(-9) no opportunity to observe the skill SOCIAL-EMOTIONAL DOMAIN
 A. 3.1 – 5.0 Years GROSS MOTOR DOMAIN
A. 3.1 – 4.0 Years
SOCIAL - EMOTIONAL P O R COMMENTS P O R COMMENTS P O R COMMENTS
DOMAIN Gross Motor P O R COMMENTS P O R COMMENTS P O R COMMENTS
1. enjoys watching activities 1. Climbs on chair or
of nearby people or other elevated piece
animals of furniture like a
2. Friendly with strangers bed without help
but initially may show 2.
Walks backwards
slight anxiety or shyness
B. 4.1 – 5.0
3. Plays alone but likes to be Gross Motor P O R COMMENTS P O R COMMENTS P O R COMMENTS
near familiar adults or 3. Runs without
brothers and sisters tripping or falling
SOCIAL - EMOTIONAL P O R COMMENTS P O R COMMENTS P O R COMMENTS 4. Walks down stairs,
DOMAIN 2 feet on each
4. Laughs or squeals aloud step, with one
in play hand held
5. Plays peek-a-boo 5. Walks upstairs
(bulaga) holding handrail, 2
6. Rolls ball interactively feet on each step
with caregiver/examiner 6. Walks upstairs
7. Hugs or cuddles toys with alternate feet
without holding
B. 5.1 – 5.11 Years handrail
7. Walks downstairs
SOCIAL - EMOTIONAL P O R COMMENTS P O R COMMENTS P O R COMMENTS
with alternate feet
DOMAIN without holding
8. Demonstrates respect for handrail
elders using terms like 8. Moves body part
“po” and “opo” as directed
9. Shares toys with others 9. Jumps up
10. Throws ball
10. Imitates adult activities overhead with
(e.g., cooking, washing) direction
11. Identifies feelings in
C. .1 – 5.11
others
12. Appropriately uses Gross Motor P O R COMMENTS P O R COMMENTS P O R COMMENTS
cultural gestures of 10. Throws ball
greetings without much overhead with
prompting (e.g., mano, direction
bless, kiss, etc.) 11. Hops 1 to 3 steps
on preferred foot
13. Comforts 12. Jumps and turns
playmates/siblings in 13. Dances
distress patterns/joins
14. Persists when faced with group movement
a problem or obstacle to activities
his wants TOTAL SCORE:
 FINE MOTOR DOMAIN

A. 3.1 – 4.0 Years

P O R COMMENTS P O R COMMENTS P O R COMM
A. 3.1 – 4.0 Years
Fine Motor
ENTS COGNITIVE DOMAIN P O R COMMENTS P O R COMMENTS P O R COMMENTS
1. Uses all 5 fingers to get
food/toys placed on flat 6. Exhibits simple pretend
surface play(feed, put doll to
2. Picks up objects with sleep)
thumbs and index finger 7. Matches objects
3. Displays a definite hand
preference
B. 4.1 – 5.0 Years
4. Puts small objects in/out
of containers COGNITIVE DOMAIN P O R COMMENTS P O R COMMENTS P O R COMMENTS
5. Holds crayon with all 8. Matches 2-3 colors
fingers of his hand 9. Matches pictures
making a fist (I.e., 10. Sorts based on shapes
palmar grasp) 11. Sorts objects based on
2 attributes (e.g., size
and color)
B. 4.1 – 5.0 Year 12. Arranges objects
Fine Motor P O R COMMENTS P O R COMMENTS P O R COMM according to size from
ENTS smallest to biggest
6. Unscrews lid of 13. Names 4-6 colors
container or unwraps 14. Copies shapes
food 15. Names 3 animals or
7. Scribbles spontaneously vegetables when asked
8. Scribbles vertical and 16. States what common
horizontal lines household items are
used for
C. 5.1 – 5.11
Fine Motor P O R COMMENTS P O R COMMENTS P O R COMM C. 5.1 – 5.11 Years
ENTS COGNITIVE DOMAIN P O R COMMENTS P O R COMMENTS P O R COMMENTS
9. Draws circle purposely 17. Cam assemble simple
10. Draws a human figure puzzles
(head, eyes, trunk, arms, 18. Demonstrates an
hands/fingers) understanding of
11. Draws a house using opposites by
geometric forms completing a statement
TOTAL SCORE: (e.g., Ang aso ay
malaki, ang daga
_____”)
19. Points to left and right
sides of body
20. Can state what is silly
or wrong with pictures
(e.g. Ano ang mali sa
larawang ito?
21 Matches upper and
lower case letters
 TOTAL SCORE: 5. Looks for completely
EXPRESSIVE LANGUAGE DOMAIN hidden object
SELF-HELP DOMAIN
A. 3.1 – 5.0 Years A. 3.1 – 4.0 Years
EXPRESSIVE P O R COMMENT P O R COMMENTS P O R COMMENTS
SELF-HELP P O R COMMENTS P O R COMMENTS P O R COMMENTS
S
LANGUAGE DOMAIN 1. Feeds self with finger
1 Uses 5-20 recognizable food (e.g. biscuits,
. words bread) using fingers
2 Uses pronouns (e.g. I, 2. Feeds self using
. me, ako, akin) fingers with spillage
3 Uses 2-3 words verb- 3. Feeds self using
. noun combinations spoon with spillage
(e.g. hingi gatas) 4. Feeds self using
4 Names objects in fingers without
. pictures spillage
B. 5.1 – 5.11 Years 5. Feeds self using
EXPRESSIVE P O R COMMENT P O R COMMENTS P O R COMMENTS spoon without
S
LANGUAGE spillage
DOMAIN
5. Speaks in B. 4.1 – 5.0 Years
grammatically correct SELF-HELP P O R COMMENTS P O R COMMENTS P O R COMMENTS
2-3 word sentences
6. Eats without need for
6. Asks “what”questions spoon feeding during
7. Asks “who” and “why” any meal
questions 7. Helps hold cup for
8. Gives account of drinking
recent experiences 8. Drinks from cup with
(with prompting) in spillage
order of occurrence
using past tense
TOTAL SCORE: C. 5.1 – 5.11Years
COGNITIVE DOMAIN SELF-HELP P O R COMMENTS P O R COMMENTS P O R COMMENTS
D. 3.1 – 4.0 Years 9. Drinks from cup
unassisted
COGNITIVE P O R COMMENT P O R COMMENTS P O R COMMENTS
S 10. Gets drink for self
DOMAIN
unassisted
1. Looks at direction of
11. Pours from pitcher
fallen object
without spillage
2. Looks for partially
12. Prepares own
object hidden
food/snack
3. Imitates behavior just
13. Prepares meals for
seen a few minutes
earlier younger
4. Offers object but will siblings/family
not release it members when no
 adult is around

SELF-HELP P O R COMMENTS P O R COMMENTS P O R COMMENTS

SELF-HELP P O R COMMENTS P O R COMMENTS P O R COMMENTS 22. Goes to the
Dressing Sub-Domain designated place to
14. Participates when
urinate (pee) or move
being dressed (e.g.
bowels (pooh) and
raises arms or lifts leg)
never does this is his
15. Pulls down gartered underpants anymore
short pants
23. Wipes/Cleans self
16. Removes sando after a bowel
movement (pooh)
17. Dresses without 24. Participates when
assistance except for bathing (e.g. rubbing
buttons and tying arms with soap)
18. Dresses without 25. Washes and dries
assistance including hands without any
buttons and tying help
26. Washes face without
Toilet Training sub-domain any help
19. Informs the adult only 27. Bathes without any
after he has already help
TOTAL SCORE:
urinated (peed) or
moved his bowels RECEPTIVE LANGUAGE DOMAIN
(poohed) in his
A. 3.1 – 5.11 Years
underpants RECEPTIVE P O R COMMENTS P O R COMMENTS P O R COMMENTS
LANGUAGE
20. Informs adult of need DOMAIN
to urinate (pee) or 1. Points to family
move bowels (pooh- member when asked
pooh) so he can be to do so
brought to a 2. Points to 5 body parts
designated place (e.g. on himself when
comfort room) asked to do so

21. Goes to the 3. Points to 5 named

designated place to pictured objects when
urinate (pee) or move asked to do so
bowels (pooh) and 4. Follows one-step
never does this is his instructions that
underpants anymore include simple
prepositions
5. Follows 2-step
instructions that
include simple
prepositions
TOTAL SCORE: