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 the direction of the fallen object
guide in knowing your child and consequently, giving appropriate care and teaching to
4 Feeds self-using fingers with spillage 2 Imitates behavior is 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 the need for spoon-feeding during any meal
scores: 5 Exhibits simple pretend play (red, put doll to sleep)
7 Helps hold the cup for drinking
-Gross Motor Domain has 13 items -Express Language Domain has 8 items 6 Matches objects
8 Drinks from cups 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 the pitcher without spillage 9 Sorts based on shapes
Each item observed is recorded three times within a year: 1) at the start of the year: 2) 12 Prepares own food/snack 10 Sorts objects based on 2 attributes (e.g., size and color)
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
( --- ) The response was not displayed 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 the overall development 18 Dresses without assistance including buttons and tying Demonstrates an understanding of the opposite by completing a
17
70-79 Suggest a slight delay in the overall development Informs the adult only after he has already urinated (peed) or moved statement
80-119 Average overall development 19 18 Points to left and right sides of the body (at least 5 body parts)
his bowels (poohed) in his underpants
120-129 Suggests slightly advanced development Informs adult of the need to urinate (pee) or move bowels (pooh-pooh) 19 Can state what is silly or wrong with pictures
130-above Suggests highly advanced development 20 20 Matches upper- and lower-case letters
so he can be brought to a designated place
Goes to the designated place to urinate (pee) or move his/her bowels 21 Copies shapes (circle, triangle)
21
and (pooh) but sometimes still does this in his/her underpants Score
GROSS MOTOR DOMAIN 1st 2nd 3rd Goes to the designated place to urinate or move his bowels and never
22
does this in his underpants anymore SOCIAL-EMOTIONAL
Climbs on the chair or other elevated piece of furniture like a bed 23 Wipes/Cleans self after a bowel movement (pooh) 1st 2nd 3rd
1 1 Enjoys watching activities of nearby people or animals
without help 24 Participates when bathing (e.g., rubbing arms with soap
2 Walks backward 2 Friendly with strangers but initially may show slight anxiety or shyness
25 Washes and dries hands without any help
3 Runs without tripping falling He Plays alone but likes to be near familiar adults or brothers and
26 Washes face without any help 3
4 Walk downstairs, 2 feet on each step, with one hand held sisters
27 Bathes without any help
5 Walks upstairs holding a handrail, 2 feet on each step 4 Laughs or squeals aloud in play
Score
6 Walks upstairs with alternate feet without holding the handrail 5 Plays peek-a-boo (Bulaga)
7 Walks downstairs with alternate feet holding the handrail 6 Rolls ball interactively with caregiver/examiner
8 Moves body parts as directed. 7 Hugs or cuddles toys
9 Jumps up 8 Demonstrates respect for elders using terms “po” and “opo”
10 Throws the ball overhead with direction 1st 2nd 3rd 9 Shares toys with others
RECEPTIVE LANGUAGE
11 Hops 1 to 3 steps on preferred foot 10 Imitates adult activities (e.g., cooking, washing)
1 Points to a family member when asked to do so
12 Jumps and turns 11 Identifies feelings in other
2 Points to 5 body parts himself when asked to do so
13 Dances patterns/joins group movement activities Appropriately uses cultural gestures of greeting without much
3 Points to 5 named pictured objects when asked to do so 12
prompting (e.g., mano, bless, kiss, etc.)
Score Follows one-step instructions that include simple prepositions (e.g., in,
4 13 Comforts playmates/siblings in distress
on, under, etc.)
14 Persists when faced with a problem or obstacle to his wants
5 Follows 2-step instructions that include simple prepositions
15 Helps with family chores (e.g., wiping the table, watering plants, etc.)
Score Curious about the environment but knows when to stop asking
FINE MOTOR DOMAIN 1st 2nd 3rd 16
questions of adults
1 Uses all 5 fingers to get foot/toys placed on a flat surface 17 Waits for turn
2 Picks up objects with thumb and index finger EXPRESSIVE LANGUAGE 1st 2nd 3rd 18 Asks permission to play with a toy being used by another
3 Displays a definite hand preference 19 Defends possessions with determination
4 Puts small objects in/out of containers 1 Uses 5-20 recognizable words 20 Plays organized group games fairly (e.g., does not cheat in order to win)
5 Holds the crayon with all the fingers of his hand making a fist 2 Uses pronouns (e.g., I, me, ako, akin) Can talk about difficult feelings (e.g., anger, sadness, worry) being
21
6 Unscrew the lid of a container or unwraps food 3 Uses 2-3 words verb-noun combinations (e.g., hingi gatas) experienced
7 Scribbles spontaneously 4 Names object in pictures Honors a simple bargain with caregiver (e.g., can play outside only after
22
8 Scribbles vertical and horizontal lines 5 Speaks in grammatically correct 2–3-word sentences cleaning/finishing his room)
9 Draws circle purposely 6 Asks “what” and “why” questions 23 Watches responsibly over younger siblings/family members
10 Draws a human figure (head, eyes, trunk, arms, hands/fingers) 7 Asks “who” and “why” questions Cooperates with adults and peers in group situations to minimize
24
11 Draws a house using geometric forms Gives an account of recent experiences (with prompting in order of quarrels and conflicts
8
occurrence using past tense) Score
Score
Score
 ECCD Summary Report
1st 2nd Assessment 3rd
Assessment Assessment SOCIODEMOGRAPHIC PROFILE
DOMAINS RS SC RS SC RS SC
Gross-Motor
Fine Motor Child's Name: __________________________________________________
Self-Help Department of Education
Receptive Language Date of Birth: ___________/__________/_______ Age: ________ Sex: ________ Region IX, Zamboanga Peninsula
Expressive Language Month Day Year
Division of Zamboanga City
Cognitive Sinunuc District
Socio-emotional Barangay: ___________________Municipality/City: _____________________ SINUNUC ELEMENTARY SCHOOL
Sum of Scaled Scores
Zamboanga City
Standard Scores
Province: ____________________________Region: _______________________
_____________________________________
*RS – Raw Score
*SC – Scale Score
INTERPRETATION
Child's Handedness: (check appropriate box) right left
1st Assessment:
Both Not yet established Philippine Early Childhood Care
________________________________ Is the child presently studying? (check appropriate box) Yes No
Development Checklist
Parent/Guardian’s Signature
2nd Assessment: (ECCD Checklist)
If yes, write name of child's school / learning center / day care? Yes No
_____________________________________________ School Year 2022-2023
________________________________
Parent/Guardian’s Signature Father's Name: _______________________________Father's Age: _______
3rd Assessment:
Father's Occupation: ___________Father's Educational Attainment:_________

Mother's Name:________________________________ Mother’s Age: _______

________________________________
Parent/Guardian’s Signature
Mother’s Occupation: ___________Mother’s Educational Attainment:_________

CERTIFICATE OF COMPLETION
COMPUTATION OF CHILD'S AGE
This is to certify that ________________________________ has completed the Kindergarten
Curriculum as prescribed by the Department of Education School year 2022-2023.
Year Month Day Examiner's LRN No:
Name
Noted: Date Tested
1st Child’s Date of
Assessment Birth
__________________
Class Adviser
EVELYN S. CABANIERO
School Principal II Child’s Age Child’s Name: ___________________________________
Date Tested _
2nd Child’s Date of
Assessment Birth
ELIGIBILITY TO TRANSFER Child’s Age
Birth Date: ___________________
Date Tested
3rd Child’s Date of Birth
Eligible to transfer and admission to __________________________________
Assessment Child’s Age
__
Sex: ___ Age: ___ as of ___________________
_________________ EVELYN S. CABANIERO __ __
Class Adviser School Principal II
_____________________ EVELYN S. CABANIERO
Class Adviser School Principal II