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Phil ECD Child RecordForm2 - Final PDF
Phil ECD Child RecordForm2 - Final PDF
Development Checklist
To the Parents:
The Philippine Early Childhood Development Checklist (Form 2) contains knowledge, skills and attitudes
of children 3.1 to 5.11 years old. This may be used as a guide in knowing your child and consequently
give appropriate care and teaching to guide their growth and development.
Content:
Every page contains different domains of development with their corresponding total scores:
• Gross Motor Domain has 13 items
• Fine Motor Domain has 11 items
• Self-Help Domain has 27 items
• Receptive Language Domain has 5 items
• Expressive Language Domain has 8 items
• Cognitive Domain has 21 items
• Social-Emotional Domain has 24 items
Each item observed are recorded two times within a school year: (1) at the start, and (2) at the end of
the school year.
Columns:
Score:
1
GROSS MOTOR DOMAIN
2
SOCIAL - EMOTIONAL MATERIALS/ P O R COMMENTS P O R COMMENTS
DOMAIN PROCEDURE
3
SOCIAL - EMOTIONAL MATERIALS/ P O R COMMENTS P O R COMMENTS
DOMAIN PROCEDURE
8. Jumps up PROCEDURE:
Ask the child to
raise both
arms.
This must be
elicited by the
interviewer.
4
SOCIAL - EMOTIONAL MATERIALS/ P O R COMMENTS P O R COMMENTS
DOMAIN PROCEDURE
TOTAL SCORE
5
FINE MATERIALS/ P O R COMMENTS P O R COMMENTS
DOMAIN PROCEDURE
6
FINE MATERIALS/ P O R COMMENTS P O R COMMENTS
DOMAIN PROCEDURE
middle fingers.
This must be
elicited by
the interviewer.
7
FINE MATERIALS/ P O R COMMENTS P O R COMMENTS
DOMAIN PROCEDURE
TOTAL SCORE
8
SELF-HELP DOMAIN
Feeding sub-domain
9
SELF-HELP MATERIALS/ P O R COMMENTS P O R COMMENTS
DOMAIN PROCEDURE
This must be
elicited by the
interviewer.
Automatically
credit if he passes
the next item.
Dressing – sub-domain
10
SELF-HELP MATERIALS/ P O R COMMENTS P O R COMMENTS
DOMAIN PROCEDURE
demonstrate how
to button and tie
to credit this item.
11
SELF-HELP MATERIALS/ P O R COMMENTS P O R COMMENTS
DOMAIN PROCEDURE
Bathing sub-domain
TOTAL SCORE
12
RECEPTIVE LANGUAGE MATERIALS/ P O R COMMENTS P O R COMMENTS
DOMAIN PROCEDURE
mouth, hands
and feet. Credit if
he can point to all
of these.
TOTAL SCORE
13
EXPRESSIVE LANGUAGE DOMAIN
1. Uses 5 - 20 PROCEDURE:
recognizable words Ask the caregiver
if the child can
clearly say 5 to 6
words aside from
“mama” and
“papa”. This will
be the minimum
number.
14
EXPRESSIVE LANGUAGE MATERIALS/ P O R COMMENTS P O R COMMENTS
DOMAIN PROCEDURE
TOTAL SCORE
COGNITIVE DOMAIN
15
COGNITIVE MATERIALS/ P O R COMMENTS P O R COMMENTS
DOMAIN PROCEDURE
16
COGNITIVE MATERIALS/ P O R COMMENTS P O R COMMENTS
DOMAIN PROCEDURE
8. Matches 2 to 3 MATERIALS: 3
colors pairs of crayons
(blue, red, yellow)
PROCEDURE:
Place 1 crayon
of each color on
the table or flat
surface. Give the
child the other
crayons arranged
in random order.
Demonstrate
a matching
response (e.g.,
red crayon with
another red
crayon) then
return the
crayons to the
child. Say,
“Put each crayon
on the one that is
just like it.” Credit
if the child can
match all colors
correctly.
17
COGNITIVE MATERIALS/ P O R COMMENTS P O R COMMENTS
DOMAIN PROCEDURE
PROCEDURE:
Place one copy of
each picture on
the table or flat
surface. Give the
child the other
pictures arranged
in random order.
Demonstrate
a matching
response (e.g.,
picture of an
apple with
another apple)
then return the
pictures to the
child. Say, “Put
each picture on
the one that is
just like it.”
Credit if the child
can match all the
pictures correctly.
18
COGNITIVE MATERIALS/ P O R COMMENTS P O R COMMENTS
DOMAIN PROCEDURE
19
COGNITIVE MATERIALS/ P O R COMMENTS P O R COMMENTS
DOMAIN PROCEDURE
circles without
demonstrating.
Credit if the child
arranges
at least one set of
shapes in
correct order
from smallest
to biggest. Allow
one trial for each
set of shapes.
20
COGNITIVE MATERIALS/ P O R COMMENTS P O R COMMENTS
DOMAIN PROCEDURE
minutes. Proceed
to the next item
after 2 minutes.
21
COGNITIVE MATERIALS/ P O R COMMENTS P O R COMMENTS
DOMAIN PROCEDURE
PROCEDURE:
Randomly
present 4 pairs
of upper case
letters. Have
the child match
these. Do the
same with 4 pairs
of lower case
letters. Credit
if the child can
match any 4
pairs, regardless
of whether these
are the upper or
lower case.
Note: The child
does not have to
know the names
of the letters.
TOTAL SCORE
SOCIAL-EMOTIONAL DOMAIN
22
SOCIAL-EMOTIONAL MATERIALS/ P O R COMMENTS P O R COMMENTS
DOMAIN PROCEDURE
23
SOCIAL-EMOTIONAL MATERIALS/ P O R COMMENTS P O R COMMENTS
DOMAIN PROCEDURE
24
SOCIAL-EMOTIONAL MATERIALS/ P O R COMMENTS P O R COMMENTS
DOMAIN PROCEDURE
TOTAL SCORE
25
Examiner’s Notes
Write down your notes, descriptions and observations on the columns provided.
Child’s background (ex. behavior/ health/ etc.) Child’s background (ex. behavior/ health/ etc.)
Family environment (ex. health of family Family environment (ex. health of family
members/family problems/economic conditions/ members/family problems/economic conditions/
etc.) etc.)
Parent’s stimulating activities for the child (What Parent’s stimulating activities for the child (What
are the activities/things that the parents do to are the activities/things that the parents do to
help stimulate the child’s development) help stimulate the child’s development)
Home environment (ex. facilities/type of house/ Home environment (ex. facilities/type of house/
household items/interaction/etc. household items/interaction/etc.
Others: Others:
26
Transfer the raw score for each domain in the table below. Using the Scaled Scores Equivalent of Raw Scores
Table, convert the raw scores to Scaled Scores appropriate to the age of the child. To arrive at the Sum of Scaled
Scores, add the Scaled Scores across all domains. To derive the Standard Score, refer to the Standard Score
Equivalent of Sums of Scaled Scores Table. Write the Child’s age on each evaluation.
AGE
1st Evaluation Date 2nd Evaluation Date
DOMAIN
Child’s Age Child’s Age
Raw Score Scaled Score Raw Score Scaled Score
Gross Motor
Fine Motor
Self-Help
Receptive Language
Expressive Language
Cognitive
Social-Emotional
Sum of Scaled Scores
Standard Score
Date Tested
27
Scaled Scores
Mark an X on the dot corresponding to the Scaled Score for each domain and connects the X’s. Write the child’s
age on each evaluation.
28
Standard Scores
Mark an X on the corresponding Standard Score for each administration and connect the X’s. Write the date for
each test administration.
29
Ensure the best possible start in your child’s life. Monitor your child’s development.
30