SOCIO-DEMOGRAPHIC PROFILE

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1 2
SOCIAL EMOTIONAL DOMAIN Child’s Name: _________________________
1 Enjoys watching activities of nearby people or animals Sex: __________ Date of Birth: ___________
Friendly with strangers but initially may show slight anxiety Philippine Early Childhood Care and
2 Age: ________ as of __________________
or shyness Address: ________________________________ Development (ECCD)
Plays alone but likes to be near familiar adults or brothers
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and sisters
Child’s Handedness: (Check Appropriate Box)
[ ] Right [ ] Left [ ] Not yet established
Checklist
4 Laughs or squeals aloud in play
Father’s Name: _____________________________________
5 Play peek a-boo( bulaga) Occupation: _______________________________________
6 Rolls ball interactively with care giver/ examiner
Educational Attainment: ______________________________
7 Hugs or cuddles toys Mother’s Name: ____________________________________
Demonstrate respect for elders using terms like “po” and Occupation: _______________________________________ Name: ________________________________________
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“opo” Educational Attainment: ______________________________
Shares toys with others Sex: _________________________________________
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SUMMARY OF ASSESMENT
1 Imitates adult activities (e.g. cooking, washing) INTERPRETATION Birthday: _____________________________________
0
EoSY
1 Identifies feelings in others LRN: -
BoSY: BoSY Date:
1 Date: __________ ___________
1 Appropriately uses cultural gestures of greeting without Age: __________ Age: To the Parents:
2 much prompting (e.g. mano, bless, kiss, etc.) DOMAINS ___________
1 Comfort playmates/ siblings in distress Scal
3 Raw Scaled Raw ed The Philippine Early Childhood Care and Development
Score Score Score Scor Checklist (Form 2) contains knowledge, skills, and
1 Persists when faced with a problem or obstacle to his e
4 wants Gross-Motor
attitudes of children 3-5.11 years old. This may be used
1 Helps with family chores (e.g.) wiping tables, watering as a guide in knowing our child and consequently give
Fine Motor
5 plants, etc.) appropriate care and teaching to guide their growth and
Curious about environment but knows when to stop Self-Help
1 development..
6 questions to adults. Receptive Language
1 Waits for turn Expressive Language
7 Cognitive ELENITA C .PAMA
1 Ask permission to play with toy being used by another
Socio-emotional Teacher
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Sum of Scaled Scores ANTONIETTA J. CARIN
1 Defends possession with determination School Principal
9 Standard Score
2 Play organized group games fairly (eg. Does not cheat in PARENT’S SIGNATURE
0 order to win)
PARENT’S SIGNATURE
2 Can talk about difficult feelings(e.g. anger, sadness,
1 worry) he experiences
2 Honors a simple bargain with caregiver (e.g. anger, 1st 2nd
Republic of the Philippines GROSS MOTOR DOMAIN
2 sadness, worry) he/she experiences
1 Climbs on chair or other elevated piece furniture like a bed without a
2 Watches responsibly over younger siblings/family Department of Education help.
3 members. Caraga Administrative Region 2 Walks backwards.
2 Cooperates with adults and peers in group situation to Division of Agusan del Sur 3 Runs without tripping or falling
4 minimize quarrels and conflicts. Esperanza District 1I 4 Walks downstairs, 2 feet on each step with one hand held
Total Score Guadalupe Central Elementary School 5 Walks upstairs holding handrail, 2 feet on each step.
Scaled Score S.Y. 2020-2021 6 Walks upstairs with alternate feet without holding handrail.
EoSY: INTERPRTATION
 7 Walks downstairs with alternate feet without holding handrail. 16 Removes sando. 3 Imitates behavior just seen a few minutes earlier.
8 Moves body parts as directed. 17 Dress without assistance except for buttons and tying. 4 Offers object but will not release it.
9 Jumps up. 18 Dress without assistance including buttons and tying. 5 Looks for completely hidden objects.
10 Throw ball overhead with direction. 19 Informs the adults only after he has already urinated (peed) or 6 Exhibits simple pretend play (feed, put doll to sleep)
11 Hops 1 to 3 steps on preferred foot. moved his bowels (pooh) in his underpants. Matches object.
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20 Inform adults of need to urinate (pee) or move bowels (pooh
12 Jumps and turns. 8 Matches 2-3 pictures.
pooh) so he can be brought to a designated place (e.g. comfort
13 Dances pattern/ joins group movement activities. room). 9 Matches Pictures
Total Score 21 Goes to the designated place to urinate (pee) or move bowels 10 Sort based on shapes
(pooh pooh) but sometimes still does this in his underpants.
Scaled SCore 11 Sorts object based on 2 attributes(e.g. size and color)
22 Goes to the designated place to urinate (pee) or move bowels
(pooh pooh) and never does this in his underpants anymore. 12 Arrange object according to size from smallest to biggest.
23 Wipes/ clean self after a bowel movement (pooh). 13 Names 4-6 colors.
1st 24 Participate when bathing (e.g. rubbing arms with soup). 14 Copies shapes.
FINE MOTOR DOMAIN 2nd
25 Washes and dried hands without any help. 15 Names 3 animals or vegetables when asked.
1 Uses all 5 fingers to get food/ toys place on flat surface.
26 Washes face without any help. 16 States what are common household items are used for.
2 Pick up object with thumb and index finger.
27 Bath without any help. 17 Can assemble simple puzzle
3 Display a definite hand preference
Total Score 18 Demonstrate an understanding of opposites by completing a
4 Puts small object in/out of containers statement (e.g. Angaso ay Malaki, angdaga ay ____)
Scaled Score
Holds crayons with all the fingers of his hand making a fist (i.e. 19 Points left and right side of the body
5 palmar grasp). 20 Can state what is silly or wrong in the pictures (e.g.
6 Unscrew lid of container or unwraps food. 1st 2nd Anoangmalisalarawangito?”)
RECEPTIVE LANGUAGE Matches upper and lower case letter.
7 Scribbles spontaneously. 21
1 Points to the family members when ask to do so.
8 Scribbles vertical and horizontal lines. Total Score
2 Points to 5 body parts on himself when asked to do so.
9 Draw circle purposely. Scaled Score
3 Points to 5 named pictured object when asked to do so.
1 Draw human figure (head, eyes, trunk, arms, hand/ fingers).
4 Follow one-step instruction that include simple preposition (e.g. in, on,
0 under, etc.).
1 Draw A house using geometric forms 5 Follow 2-step instruction that include prepositions.
1 Total Score
Total Score Scaled Score
Scaled Score

EXPRESSIVE LANGUAGE 1st 2

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1st 2nd
SELF HELP d

1 Feed self with finger food(e.g. biscuits, bread) using fingers 1 Uses 5-20 recognizable words.
Feeds self-using fingers with spillage. 2 Use pronouns (e.g. I, me, ako, akin).
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3 Use 2-3 word verb- noun combination( e.g. hingigatas )
3 Feeds self-using spoon with spillage.
4 Names object in pictures.
4 Feeds self-using fingers without spillage.
5 Speak in grammatically correct 2-3 word sentences.
5 Feeds self-using spoon without spillage. 6 Asks “what” questions.
6 Eats without need for spoon feeding during any meal. 7 Asks “who” and “why” questions.
7 Helps hold cup for drinking. 8 Gives account of recent experiences (with prompting) in order
8 Drinks from cup with spillage of occurrence using past tense.
Total Score
9 Drink from cup unassisted.
Scaled SCORE
10 Gets drink for self-unassisted.
11 Pours from pitcher without spillage.
12 Prepares own food/ snack.
13 Prepares meals for younger siblings/ family members when no COGNITIVE DOMAIN 1s 2nd
adult is around. t
14 Participate when being dressed (e.g. raises arms or lifts leg). 1 Looks direction of fallen objects.
Pulls down gartered short pants. 2 Looks for partially hidden objects.
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