MIMAROPA REGION

Division of Occidental Mindoro

District
SCHOOL
LRN:

SOCIO-DEMOGRAPHIC PROFILE
ID picture
Name: ______________________________________________ here
Birthday: _______________ Gender: ______ Birth Order : ____ of ____
Birthplace: __________________________________________
Child Handedness: ____Right ____Left ____Both ____Not yet established
Address:____________________________________________________________
Father Age Eudc’l Attainment Occupation
________________________ _______ _____________________ ______________
Mother
________________________ _______ _____________________ ______________
Age of Mother when she had the child: _____ Number of Children: _____

Sa mga Magulang:

Ang Philippine Early Childhood Checklist ay nagtataglay ng mga kakayahan, ugali at kaalaman ng mga
batang 3 hanggang 5 taon at 11 buwan. Ito ay maaaring gamiting gabay sa pagkilala ng inyong anak at sa kalaunan
ay makagagawa ng angkop na pag-aalaga, pagtuturo at paggabay sa kanilang paglaki at pag-unlad.

_________________________________ _________________________________
Punungguro Guro

PHILIPPINE EARLY CHILDHOOD DEVELOPMENT CHECKLIST

1st Assessment 2nd Assessment 3rd Assessment
DOMAINS Date: Date: Date:
Age: Age: Age:
Raw Score Scaled Score Raw Score Scaled Score Raw Score Scaled Score
Gross Motor
Fine Motor
Self-help
Receptive Language
Expressive Language
Cognitive
Socio-emotional
Sum of Scaled Scores
Standard Score
Interpretation of Standard Score

Interpretation of Score Scaled Score Standard Score

Suggest significant delay in over-all development 1-3 69 & below
Suggest slight delay in over-all development 4-6 70 -79
Average development 7-13 80 - 119
Suggest slight advanced development 14-16 120 – 129
Suggest highly advanced development 17-19 130 & above

Iskor: Columns
() – Kaya o alam gawin ng bata P – Present or the child can do the task
( - ) – Di kaya o di sumasagot ang bata O – Observed or the child was observed doing the task
(-9) – No opportunity to observe the skill R – Report given by the parents/caregiver about the skill
 GROSS MOTOR DOMAIN
1 2 Comment 3 Comment
No. ITEMS Comment
P O R P O R P O R
Climbs on chair or other elevated piece of
1.
furniture like a bed without help
2. Walks backwards
3. Runs without tripping or falling
Walks down stairs, 2 feet on each step, with
4.
one hand held
Walks up stairs holdinghandrail, 2 feet on each
5.
step
Walks upstairs with alternate feet without
6.
holding handrail
Walks downstairs withalternate feet without
7. holding
handrail
8. Moves body part as directed
9. Jumps up
10. Throws ball overhead with direction
11. Hops 1 to 3 steps on preferredfoot
12. Jumps and turns
Dances patterns / joins group
13.
movement activities
Total Score

FINE MOTOR DOMAIN

ITEMS Comment Comment Comment

Uses all 5 fingers to get food/toys placed on flat

1.
surface

2. Picks up objects with thumb and index finger

3. Displays a definite hand preference

4. Puts small objects in/out of containers

Holds crayon with all the fingersof his hand

5.
making a fist (I.e.,palmar grasp)

6. Unscrews lid of container or unwraps food

7. Scribbles spontaneously

8. Scribbles vertical and horizontal lines

9. Draws circle purposely

Draws a human figure (head, eyes, trunk,

10.
arms, hands/fingers)

11. Draws a house using geometric forms

Total Score

SELF-HELP DOMAIN
ITEMS Comment Comment Comment
Feeds self with finger food (e.g. biscuits, bread)
1.
using fingers

2. Feeds self using fingers with spillage

3. Feeds self using spoon with spillage

4. Feeds self using fingers without spillage

5. Feeds self using spoon without spillage

Eats without need for spoon feeding during any

6.
meal

7. Helps hold cup for drinking

8. Drinks from cup with spillage

9. Drinks from cup unassisted

10. Gets drink for self unassisted

11. Pours from pitcher without spillage

12. Prepares own food/snack

Prepares meals for younger siblings and or

13.
family members when no adult is around
Participates when being dressed (e.g. raises
14.
arms or lifts leg)

15. Pulls down gartered short pants

16. Removes sando

Dresses without assistance including buttons

17.
and tying
Informs the adult only after he has already
19. urinated (peed) or moved his bowels (poohed)
in his underpants
Informs adult of need to urinate (pee) or move
20. bowels (pooh-pooh) so he can be brought to a
designated place (e.g. comfort room)
Goes to the designated place to urinate (pee)
21. or move bowels (pooh) but sometimes still
does this in his underpants
Goes to the designated place to urinate (pee)
22. or move bowels (pooh) and never does this is
his underpants anymore
Wipes/Cleans self after a bowel movement
23.
(pooh)
Participates when bathing (e.g. rubbing arms
24.
with soap)

25. Washes and dries hands without any help

26. Washes face without any help

27. Bathes without any help

Total Score

RECEPTIVE LANGUAGE DOMAIN

ITEMS Comment Comment Comment
1. Points to family member when asked to do so

Points to 5 body parts on himself when asked

2.
to do so
Points to 5 named pictured objects when asked
3.
to do so
Follows one-step instructions that include
4.
simple prepositions (e.g., in, on, under, etc.)
Follows 2-step instructions that include simple
5.
prepositions

Total Score

EXPRESSIVE LANGUAGE DOMAIN

ITEMS Comment Comment Comment
1. Uses 5-20 recognizable words

2. Uses pronouns (e.g. I, me, ako, akin)

Uses 2-3 words verb-noun combinations (e.g.

3.
hingi gatas)

4. Names objects in pictures

Speaks in grammatically correct 2-3 word

5.
sentences

6. Asks “what” questions

7. Asks “who”' and “why” questions

Gives account of recent experiences (with

8. prompting) in order of occurrence using past
tense

Total Score
 COGNITIVE DOMAIN
ITEMS Comment Comment Comment
1. Looks at direction of fallen object

2. Looks for partially hidden object

Imitates behaviour just seen a few minutes

3.
earlier

4. Offers object but will not release it

5. Looks for completely hidden object

Exhibits simple pretend play (feed, put doll To

6.
sleep)

7. Matches objects

8. Matches 2 – 3 colors

9. Matches pictures

10. Sorts based on shapes

Sorts objects based on 2 attributes (e.g., size

11.
and color)
Arranges objects according to size from
12.
smallest to biggest

13. Names 4 – 6 colors

14. Copies shapes

15. Names 3 animals or vegetables when asked

States what common household items are used

16.
for

17. Can assemble simple puzzles

Demonstrates an understanding of opposites

18. by completing a statement (e.g., Ang aso ay
malaki, ang daga ay _____”)

19. Points to left and right sides of body

Can state what is silly or wrong with pictures

20.
(e.g. Ano ang mali sa larawang ito?)

21. Matches upper and lower case letters

Total Score

SOCIO-EMOTIONAL DOMAIN
ITEMS Comment Comment Comment
Enjoys watching activities of nearby people or
1.
animals
Friendly with strangers but initially may show
2.
slight anxiety or shyness
Plays alone but likes to be near familiar adults
3.
or brothers and sisters

4. Laughs or squels aloud in play

5. Plays peek-a-boo (bulaga)

6. Rolls ball interactively with caregiver/examiner

7. Hugs or cuddles toys

Demonstrates respect for elders using terms

8.
like “po” and “opo”

9. Shares toys with others

10. Imitates adult activities (e.g., cooking, washing)

11. Identifies feelings in others

Appropriately uses cultural gestures of greeting

12. without much prompting (e.g., mano, bless,
kiss, etc.)

13. Comforts playmates/siblings in distress

 Persists when faced with a problem or obstacle
14.
to his wants
Helps with family chores (e.g., wiping tables,
15.
watering plants, etc.)
Curious about environment but knows when to
16.
stop asking questions of adults

17. Waits for turn

Asks permission to play with toy being used by

18.
another

19. Defends possessions with determination

Plays organized group games fairly (e.g., does

20.
not cheat in order to win)
Can talk about difficult feelings (e.g., anger,
21.
sadness, worry) he experiences.
Honors a simple bargain with caregiver (e.g.,
22. can play outside only after cleaning/fixing his
room)
Watches responsibly over younger
23.
siblings/family members
Cooperates with adults and peers in group
24.
situations to minimize quarrels and conflicts
Total Score

Name of examiner: ______________________________________________________

Date administered: ______________________________________________________
Place where Test is Administered:______________________________________________

To the examiner:
Please fill out the spaces below for additional information. Thank you very much. Write
down your notes, descriptions and observations on the following points:

Child’s background (e.g. behaviour/ health/ etc.)

________________________________________________________________________
________________________________________________________________________
________________________________________________________________________

Family Environment (e.g. health of family members/ family problems/ economic conditions/etc.)
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________

Parents’ Stimulating Activities for the child (What are the activities/ things that the parents do to
help stimulate the child’s development?)
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________

Home Environment (e.g. facilities/ type of house/ household items/interaction/ etc.)

________________________________________________________________________
________________________________________________________________________
________________________________________________________________________

Others
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________