Name: ______________________________ Nickname: ________________ TOTAL SCORE

Date of Birth:_________________________ Age: ________ 4. Feeds self using fingers with spillage. EXPRESSIVE LANGUAGE DOMAIN
Sex: _______ 5. Fedds self using fingers without spillage. EXPRESSIVE LANGUAGE PRESENT COMMENTS
6. Eats without need for spoonfeeding during 1. Uses 5-20 recognizable words.
GROSS MOTOR DOMAIN any meal. 2. Uses pronouns (e.g. I, me, ako, akin)
GROSS MOTOR PRESENT COMMENTS 7. Helps hold cup for drinking. 3. Uses 2-3 words verb-noun combinations (e.g.
1. Climbs on chair or other elevated piece of 8. Drinks from with spillage. hingi gatas).
furniture like a bed without help. 9. Drinks from cup unassisted. 4. Names objects in pictures.
2. Walks backwards 10. Gets drink for self unassisted. 5. Speaks in grammatically correct 2-3 word
3. Runs without tripping or falling. 11. Pours from pitcher without spillage. sentences.
12. Prepares own food/snack. 6. Asks “what” questions.
4. Walks down stairs, 2 feet on each step, with 13. Prepares meals for younger siblings/family 7. Aks “who” questions.
one held. members when no adults is around. 8. Gives account of recent experiences (with
5. Walks upstairs holding handrail, 2 feet on 14. Participates when being dressed(e.g., raises prompting) in order of occurence using past
each step. arms or lifts leg). tense.
6. Walks upstairs with alternate feet without 15. Pulls down gartered short pants. TOTAL SCORE
holding handrail.
16. Redmoves sando. COGNITIVE DOMAIN
7. Walks downstairs with alternate feet without
17. Dresses without assistance including COGNITIVE PRESENT COMMENTS
holding handrail.
buttons and tying. 1. Looks at direction of fallen object.
8. Moves body parts as directed.
18. Dresses without assistance except for 2. Looks dor partially hidden object.
9. Jumps up. buttons and tying. 3. Immitates behavior just seen a few minutes
10. Throws ball overhead with direction. 19. Informs the adult only after he has already earlier.
urinated (peed) or moved his bowels 4. Offers object but will not release it.
11. Hops 1-3 steps on preffered foot. (poohed) in his underpants. 5. Looks for completely hidden object.
12. Jump and turn. 20. Informs adult of need to urinate (pee) or 6. Exhibits simple pretend play (feed, put doll to
13 Dances patterns/joins group movement moved bowels (pooh-pooh) so he can be slep).
activities. brought to designated place (e.g. comfort 7. Matches objects.
TOTAL SCORE room). 8. Matches 2-3 colors.
21. Goes to the designated place to urinate 9. Matches pictures.
FINE MOTOR DOMAIN
(pee) or move bowels (pooh) and never 10. Sorts based on shapes.
FINE MOTOR PRESENT COMMENTS does this is his underpants anymore>
1. Uses 5 fingers to get food/toys placed on flat 11. Sorts objects based on 2 attributes (e.g. size
22. Goes to the designated place to urinate and color).
surface. (pee) or move bowels (pooh) and never
2. Picks up objects with thumb and index 12. Arranges objects according to size from
does does this is his underpants anymore. smallest to biggest>
finger. 23. Wipes/clean self after a bowel movement..
3. Display a definite hand preference. 13. Names 4-6 colors.
24. Participates when bathing (e.g. Rubbing 14. Copies shapes.
4. Puts small objects in/out of containers. with soap).
5. Holds crayon with all the fingers of his hand 15. Names 3 animals or vegetables when asked.
25. Washes and dries hands without any help. 16. States what common household item are
making a fist(i.e, palmar grasp) 26. Washes face without any help.
6. Unscrews lid of container or unwraps food. used for.
27. Bathes withou any help. 17. Can assemble simple puzzles.
7. Scribbles spontaneously. TOTAL SCORE
8. Scribbles vertical and horizontal. 18. Demonstrates an understanding of opposites
RECEPTIVE LANGUAGE by completing a statement (e.g. Ang aso ay
9. Draws circle purposely. RECEPTIVE LANGUAGE PRESENT COMMENTS
10. Draws a human figure( head, eyes, trunk malaki. Ang daga ay maliit.)
1. Points to family members when asked to 19. Points to left and right side of the body.
arms, hand /fingers). do so.
11. Draws a house using geometric forms. 20. Can state what is silly on wrong with pictures
2. Points to 5 body parts on himself when (e.g. Ano ang mali sa larawang ito?)
TOTAL SCORE asked to do so.
SELP-HELP DOMAIN 21. Matches upper and lower case letters.
3. Points 5 named picturd objects when asked TOTAL SCORE
SELP-HELP PRESENT COMMENTS to do so.
1. Feeds self with finger food(e.g, biscuits, SOCIAL EMOTIONAL DOMAIN
4. Follws one-step instructions that include SOCIAL-EMOTIONAL PRESENT COOMENTS
bread) using fingers. simple prepositions (e.g. in, on, under, etc.)
2. Feeds self using spoon with spillage 1. Enjoys watching activities of nearby people or
5. Follows 2-step instructions that include animals.
3. Feeds self using spoon without spillage. simple preposition. 2. Friendly with strangers but initially may show
 slight anxiety or shyness.
3. Plays alone but likes to be near familliar adults
or brothers and sisters.
4. Laughs or squels aloud in play.
5. Plays peek-a-boo (bulaga).
6. Rolls ball interactively with Republic of the Philippines
caregiver/examiner. Department of Education
7. Hugs or cuddles toys. JUNE OCTOBER MARCH Region IV – MIMAROPA
8. Demonstrates respect for elders using terms LUBANG INTEGRATED SCHOOL
like “po” and “opo”.
9. Shares toys with others.
Sum of Scaled Lubang
10. Immitates adult activities (e.g. cooking, Scores
washing)
11. Identifies feelings in others.
Standard Philippine Early Childhood
12. Appropriately uses cultural gestures of
greeting without much prompting (e.g. mano, Score Development Checklist
bless, kiss, etc.) Form 2
13. Comforts playmates/siblings in distress. Interpretation (3.0-5.11 years old)
14. Persists when faced with problem or obstacle
to his wants. of Standard
15. Helps with family chores( e.g. wiping tables, Score
watering plants, etc.)
16. Curious about environment but knows when
to stop asking questions of adults.
17. Waits for turn.
18. Asks permission to play with toy being used by
another.
19. Defends possessions with determination.
20. Plays organized group games fairly (e.g. does
not cheat in order to win).
21. Can talk about difficult feelings (e.g. anger, PARENT’S/GUARDIAN NAME AND SIGNATURE
sadness, worry) he experiences.
22. Honors a simple bargain with caregiver (e.g.
can play outside only after cleaning/fixing his
JUNE
room). OCTOBER
23. Watches responsibly over younger MARCH
siblings/family members.
24. Cooperates with adults and peers in group
situations to minimize quarrels and conflicts.
TOTAL SCORE
Child’s Name:
Birthdate: Age: S.Y: 2013-2014
LRN: Sex: Male

ERMELITA T. VILLAR VANESSA V. NAZARENO

ES PRINCIPAL II TEACHER