FORM D: MULTI-FACTORED ASSESSMENT TOOL (MFAT)

LR
Learner’s Code:
N
DIRECTIONS: Check () YES if the child performed the task, or the item indicated was observed. If not, check NO and
write in the next column the learner’s response or reaction towards the given task/activity.

TIME STARTED: _____________________________ TIME ENDED:______________________________

Activity 1 Title: LET’S TALK

ITEM YE
ASSESSMENT ACTIVITY NO Actual Learner’s Response
CODE S
Time Started: __________________________________
Hello, good morning/good afternoon!

COM- Note: The teacher drops a bunch of keys on the floor to

AU-1 produce sounds.

1. Turns head to source when sound is heard

Note: First, the teacher introduces her/himself.
What is your name?
COM-
EL-2
2. Tells one’s name / identifies oneself

Note: The teacher taps the table.

Do you hear the tapping sound on the table?
COM-
AU-3 3. Responds to or nods head appropriately when spoken
to

Repeat it.
COM-
AU-4 4. Repeats table tapping patterns correctly

Do the following:
You stand
Turn around
COM-
Sit down
RL-5
5. Recognizes two to three word instructions

Note: Observed in item 5

COM-
RL-6 6. Responds to two-word combination

Who are the members of your family? What are their

COM- names?
EL-7
7. Calls family members by name
Tell me about your family.
COM-
EL-8
8. Tells stories to peers/class and teacher coherently
Answer the following questions:
a. What do you do before going to school?
b. What are the things you see in school?
COM- c. Who are in school?
EL-9 d. What do you do in school?

9. Answers wh- questions

© October 2017, Department of Education. For NTOT. Page 1 of 15

FORM D: MULTI-FACTORED ASSESSMENT TOOL (MFAT)
Activity 1 Title: LET’S TALK
ITEM YE
ASSESSMENT ACTIVITY NO Actual Learner’s Response
CODE S
Note: The teacher gets three (3) objects from the box one
at a time. (ball, pencil, book)
COM-
RL-10 What is this?

10. Identifies familiar objects when presented

Describe it. (ball, pencil, book)
COM-
EL-11 11. Describes simple and familiar objects

Note: Place the letters and number cards on the table.

(a,b,w,r,s,t,1,2,3,4,5)
COM-
RL-12 Pick the letters.

12. Picks up the letters

What is the sound of a motorcycle?
COM- 13. Makes random non-speech sounds (e.g. wooh, wooh,
SP-13 etc.)

Note: The teacher reads the words and let the child
answer the following questions:

Identify the initial sound of the words: ask, act, and.

COM-
Identify the medial sound of the words: pat, mat, bat.
RL-14
Identify the final sound of the words: Ana, Aga, Eva.

14. Discriminates initial, medial and final sounds

Repeat what I will say, “My Teacher, My Hero”.

Indicator: Repeats the sentence

COM-
EL-15 15. Imitates words/phrases and/or local TV/radio
commercial

Note: Let the child read the words.

COM- Read the following words: is, are, has, for, give, his.
RL-16
16. Recognizes pre-primer and primer sight words

Recite/sing any nursery rhyme that you know.

COM-
17. Recites common nursery rhymes
EL-17

Note: To be observed during the conversation

COM-
18. Prefers talking rather than using gestures and physical
SP-18
communication

Note: To be observed during the conversation

COM-
EL-19 19. Answers in complete sentence when asked

© October 2017, Department of Education. For NTOT. Page 2 of 15

FORM D: MULTI-FACTORED ASSESSMENT TOOL (MFAT)
Activity 1 Title: LET’S TALK
ITEM YE
ASSESSMENT ACTIVITY NO Actual Learner’s Response
CODE S
Note: To be observed during the conversation
COM-
EL-20
20. Expresses thoughts or ideas correctly
Note: To be observed during the conversation
COM-
SP-21 21. Speaks in an articulated manner in (e.g. without
stuttering)

Note: To be observed during the conversation

COM-
VO-22 22. Controls volume of voice when in conversation

Note: To be observed during the conversation

COM-
23. Speaks with voice quality when in conversation (e.g.
VO-23
pitch)

Note: To be observed during the conversation

COM-
24. Speaks with uninterrupted flow of sounds, words,
VO-24
syllables, and phrases

Do you feel tired? hungry? thirsty? need to go to the

toilet? What do you want to do?
COM-
EL-25 25. Expresses basic needs and/or wants (verbal, gestural,
sign)

Time Ended:_______________________

Activity 2 Title: TREASURE BOX

ITEM YE
ASSESSMENT ACTIVITY NO Actual Learner’s Response
CODE S
Time Started: __________________________________
Note: Teacher gets 3 objects from the treasure box and
place them on the table.

COG - From your left, which object is in the middle? last?

NU-1 first?

1. Recognizes position of objects-first/middle/last

Note: Teacher gets cut-out pictures from the box and lay
them down on the table.

Here are cut-out pictures of different objects. Group

COG-
them according to shapes. (triangle, rectangle, square,
SA- 2
and circle)

2. Sorts objects based on shapes

COG- Arrange the cut-out pictures of objects from smallest

SA-3 to biggest.

3. Arranges objects according to size from smallest to

© October 2017, Department of Education. For NTOT. Page 3 of 15
FORM D: MULTI-FACTORED ASSESSMENT TOOL (MFAT)
Activity 2 Title: TREASURE BOX
ITEM YE
ASSESSMENT ACTIVITY NO Actual Learner’s Response
CODE S
biggest

I have here a picture, get another picture on the table

that is of the same size with the one I am holding.
COG-
SA-4
4. Matches objects according to size

Put together cut-out pictures that are red.

COG- Put together cut-out pictures that are small.

SA-5
5. Sorts objects based on 2 attributes (e.g. color & size)

Get three shapes with the same color.

COG-
SA-6
6. Matches 2 – 3 colors

Name the letters of the alphabet.

COG-
RD-7 7. Names the letters of the alphabet

Note: Teacher places letters M, R, S, T, A, and P on the

table and prepares the matching small letters with two
distractor letters.

COG- I have here 6 big letters of the alphabet. Get the small
SA-8 letters on the table and match them with the big
letters.

8. Matches big with small letters

Count from one to twenty.

COG-
NU-9 9. Rote counts 1 to 20

Get three number cards from the treasure box one at

COG- a time and tell me what number it is.
NU-10
10. Identifies numbers from 1 to 20
Note: Place the number cards on the table. (2,5,7)

Get the popsicle sticks from the treasure box.

COG-
Show the number of popsicle sticks that matches the
NU- 11
number on the card.

11. Associates numbers 1 to 10 with objects

Using popsicle sticks, add the following:

1) 8+ 2 = ___
COG- 2) 5+ 5 = ___
NU-12 3) 1+ 9= ___

12. Adds objects to get a sum of 10

© October 2017, Department of Education. For NTOT. Page 4 of 15

FORM D: MULTI-FACTORED ASSESSMENT TOOL (MFAT)
Activity 2 Title: TREASURE BOX
ITEM YE
ASSESSMENT ACTIVITY NO Actual Learner’s Response
CODE S
Using popsicle sticks, subtract the following:

1) 11 – 1 =___
COG- 2) 12 – 2 = ___
NU-13 3) 13 – 3 =___

13. Subtracts objects to get a difference of 10.

Note: Follow the same instruction for the P10, P5, and
P1 coins.
COG-
Get a 20-peso bill from the treasure box.
NU-14
14. Identifies Philippine Peso Bills and Coins

What is/are the missing number/s?

(1, 2, ____, 4, 5, ____
2, 4, 6, __, 10, 12...
COG- 3, 6, ____, ...
RE-15 5, ___, 15...)

15. Follows number patterns

Note: Teacher sets the time at 3:00, 7:00, and 9:00.

Look at the clock I am holding. Tell me what time it

COG-
is.
NU-16
16. Identifies time by the hour

Identify the events in the pictures. Which do you think

comes first? last? Arrange the pictures.
COG-
RE-17
17. Sequences picture story of 4 to 6 events

Look at the pictures again. Tell me which event

happened in the morning? afternoon? night?
COG-
RE-18 18. Identifies time concept of the day (morning,
afternoon, night)

Arrange the puzzle to complete the picture.

COG-
RE-19 19. Completes simple puzzles

Note: In case the learner was not able to do the puzzle,

the teacher shows the guide picture.

COG- Point the head, neck, shoulder, hands, fingers, legs,

CL-20 knees and toes.

20. Identifies body parts

Which part of the body is for seeing? hearing?

tasting? feeling? smelling?
COG-
CL-21
21. Identifies five senses

© October 2017, Department of Education. For NTOT. Page 5 of 15

FORM D: MULTI-FACTORED ASSESSMENT TOOL (MFAT)
Activity 2 Title: TREASURE BOX
ITEM YE
ASSESSMENT ACTIVITY NO Actual Learner’s Response
CODE S
Look at these two pictures. What are the
differences between these pictures?
COG-
RE-22
22. Identifies what is different in the picture

What is missing in the picture?

COG-
RE-23 23. Identifies what is missing in the picture

Who are the members of your family?

COG-
RT-24 24. Name members of the family.

Note: Observe the reaction of the learner and ask the

learner which of the two books he likes most?
COG-
Get 2 books from the treasure box.
RD-25
25. Exhibits interest in books

Time Ended:_______________________

Activity 3 Title: MY DAILY ROUTINE

ITEM YE
ASSESSMENT ACTIVITY NO Actual Learner’s Response
CODE S
Time Started: _________________________________
Suppose you are taking a bath. Show me how you do it.
DLS-
1. Takes a bath
GH-1
Show me how you brush your teeth.
DLS-
GH-2 2. Brushes own teeth

Note: Teacher gives a polo shirt/blouse and

shorts/skirt/pants and ask the learner to stand and wear
it.
DLS-
DR-3 Show me how you put on your clothes.

3. Puts on clothes.

(If the learner does not button the clothes, the teacher
may instruct the learner to do the instruction below.)

Show me how to button your polo shirt/blouse.

DLS-
DR-4
Then show me how you unbutton your shirt/blouse.

4. Buttons and unbuttons clothes

DLS- Note: Let the learner stand and demonstrate how to zip
DR-5 and unzip pants/skirts/shorts.
© October 2017, Department of Education. For NTOT. Page 6 of 15
FORM D: MULTI-FACTORED ASSESSMENT TOOL (MFAT)
Activity 3 Title: MY DAILY ROUTINE
ITEM YE
ASSESSMENT ACTIVITY NO Actual Learner’s Response
CODE S

Show me how to zip and unzip your

pants/skirts/shorts.

5. Zips and unzips pants

Show me how you take off your clothes.

DLS-
DR-6 6. Takes off clothes

Show me how you put on your shoes.

DLS-
DR-7 7. Puts on shoes

Note: If the learner is already wearing shoes with lace,

ask the child to untie first, then tie.

Show me how you tie your shoe lace.

DLS-
DR-8 Then untie your shoe lace.

8. Ties and Unties shoe lace

Note: Teacher will let the child demonstrate.

DLS-
Show me how to comb or brush your hair.
GH-9
9. Combs or brushes hair
Note: Give the learner a handkerchief or a tissue paper.

Show me how you wipe or blow your nose using the

DLS-
tissue paper or handkerchief.
GH-10
10. Wipes / blows nose properly

Note: Bring the child to the washroom.

If there is none, provide a pail of water, dipper, basin,
soap, and towel.
DLS-
GH-11 Wash your hands, then dry them.

11. Washes and dries hands

Note: Provide the learner with plate, spoon, fork, glass,

and placemat.
DLS-
Show me how to set the table.
FE-12
12. Sets the table

DLS- Note: Provide the learner with bread, sandwich spread

FE-13 in a bottle, and spoon.

If the child is not exposed to preparing a

sandwich, he/she may be interviewed on other meals that
he/she has prepared like cooking egg/camote, etc.

© October 2017, Department of Education. For NTOT. Page 7 of 15

FORM D: MULTI-FACTORED ASSESSMENT TOOL (MFAT)
Activity 3 Title: MY DAILY ROUTINE
ITEM YE
ASSESSMENT ACTIVITY NO Actual Learner’s Response
CODE S
Show me how to prepare a sandwich.

13. Prepares a 2-3 step meal

Note: The assessor will provide any container that the

learner will open and close. This may be observed while
the child is preparing the meal.

DLS- Show me how to open bottles/ jars and other food

FE-14 containers, then close them.

14.Opens and closes bottles/jars/and food containers

boxes/ food

Note: The assessor will provide the table

napkin/sandwich wrapper to the learner.

Wrap your sandwich.

DLS-
FE-15
Now, you’re ready to eat your sandwich. Unwrap it.

15.Wraps /Unwraps

Note: The assessor will verify this with the parent

through observation
DLS-
Do you consume the food on plate?
FE-16
16.Consumes food on one’s plate

Note: Validate through interview with the parent.

DLS- Can you serve yourself from a serving plate? Show

FE-17 me how.

17. Serves self from serving plate

Note: The assessor will provide the eating utensils to be
used. Let the learner pretend using eating utensils.

DLS- Do you know how to use your eating utensils

FE-18 properly? Show me how.

18. Uses eating utensils properly

Show me how you drink from a cup/glass/bottle.

DLS-
FE-19 19. Drinks from a cup/glass/ bottle

Note: Validate through interview with the parents.

Do you clear your own place after eating at the

DLS-
table? Show me how.
FE-20
20. Clears own place (at table) after eating

DLS- Note: Compare answer with Activity 1 item no. 25. This
TL-21 may be observed during the duration of the assessment.

© October 2017, Department of Education. For NTOT. Page 8 of 15

FORM D: MULTI-FACTORED ASSESSMENT TOOL (MFAT)
Activity 3 Title: MY DAILY ROUTINE
ITEM YE
ASSESSMENT ACTIVITY NO Actual Learner’s Response
CODE S
Do you tell your teacher if you need to go to the
toilet/CR?

21. Expresses the need to go to the toilet

Note: Validate through interview with the parents. This

may be observed during the duration of the assessment.
DLS-
Do you flush the toilet after using it?
TL-22
22. Flushes toilet after use

Note: Validate through interview with the parents. This

may be observed during the duration of the assessment.
DLS-
After using the toilet, do you wash your hands?
TL-23
23. Cleans self after toileting

Note: Show 6 danger signs/symbols:

 slippery when wet
 high voltage
 poisonous/toxic
 flammable
 road under construction
 falling debris
DLS-
HS-24
Are you familiar with these symbols?

What does this symbol mean? When you see this,

what should you do?

24. Identifies danger signs and symbols

Here are pictures of broken glasses, high places,

streets or sharp and pointed objects. What will you
do if you see these? Why?
DLS-
HS-25
25. Keeps out of danger, broken glass/high places,
streets or sharp and pointed objects

Time Ended:_______________________

Activity 4 Title: WHETHER WEATHER

ITEM YE
ASSESSMENT ACTIVITY NO Actual Learner’s Response
CODE S
Time Started: __________________________________
Do you play with your friends? What games do you
play?
SEB-
SS-1
1. Plays with peers

SEB- Note: Interview the teacher adviser if the learner can

SS-2 follow rules during games.

© October 2017, Department of Education. For NTOT. Page 9 of 15

FORM D: MULTI-FACTORED ASSESSMENT TOOL (MFAT)
Activity 4 Title: WHETHER WEATHER
ITEM YE
ASSESSMENT ACTIVITY NO Actual Learner’s Response
CODE S

2. Follows rules and regulations.

When is the best time to play with friends?

Why?
SEB-
SS-3
3. Participates in the conversation

Note: Interview the teacher adviser.

SEB- What do you do if you lose/win? Why?

SS-4
4. Shows sportsmanship

I have here pictures of different faces. Which of these

shows the feeling when you win? lose?
SEB-
SS-5
5. Expresses appropriate emotions

Note: Let the learner name at least three friends.

SEB-
How many friends do you have? Name them.
SS-6
6. Makes friends easily

What activities does your mother/father do at home?

SEB-
Show me how.
SS-7
7. Imitates adult activities
Do you have personal belongings? Name some of
SEB- them.
ES-8
8. Identifies personal belongings.
Note: Free hand drawing.

How many are you in the family? Draw the members

SEB-
of your family. Encircle where you are. (Items number
ES-9
9 and 10)

9. Identifies self as a member of a family/cultural group

Note: The teacher observes the behavior of the learner
while doing the activity number 9.
SEB-
ES-10
10. Shows initiative to work on tasks

Note: The teacher gives constructive criticisms on the

drawing. Refer to Item number 9.
SEB-
ES-11
11. Accepts criticisms positively

Note: Based on the reaction of the learner on item

number 11.
SEB-
ES-12
12. Shows self-control

SEB- Note: Prior knowledge of the teacher on the learner

ES-13 should be noted.

© October 2017, Department of Education. For NTOT. Page 10 of 15

FORM D: MULTI-FACTORED ASSESSMENT TOOL (MFAT)
Activity 4 Title: WHETHER WEATHER
ITEM YE
ASSESSMENT ACTIVITY NO Actual Learner’s Response
CODE S
13. Engages in communication with others

Note: The courteous expressions used by the learner.

How do you greet your teacher in the:

a) morning?
SEB- b) afternoon?
SS-14
When you receive a gift, what will you say?

14. Uses courteous expressions appropriately

If you accidentally bump somebody, what will you

say?
SEB-SS
15
15. Apologizes when necessary.

Note: This can be observed during the administration.

Does the learner pay attention to someone who is
SEB-SS talking?
16
16. Pays attention to someone talking

If you have a difficult homework, what will you do?

SEB-SS
17 17. Seeks or accepts help when he/she needs it.

Prior knowledge of the teacher on the learner should be

noted.
SEB-SS
18
18. Waits for one’s turn

Note: If not observed during the assessment, validate

from the teacher.
SEB-SS
19
19. Displays sense of humor

Prior knowledge of the teacher on the learner should be

noted.
SEB-SS
20 20. Leads a group activity

Prior knowledge of the teacher on the learner should be

noted.
SEB-SS
21
21. Asks permission to use things owned by others

Prior knowledge of the teacher on the learner should be

noted.
SEB-SS
22
22. Seeks older friends

Prior knowledge of the teacher on the learner should be

noted.
SEB-SS
23
23. Prefers working alone

© October 2017, Department of Education. For NTOT. Page 11 of 15

FORM D: MULTI-FACTORED ASSESSMENT TOOL (MFAT)
Activity 4 Title: WHETHER WEATHER
ITEM YE
ASSESSMENT ACTIVITY NO Actual Learner’s Response
CODE S
Note: The teacher should act as one of the characters in
the role playing.

I have four pictures here. Pick one and let’s act it out.
a. At Home – mother cooking
SEB-SS
b. School – teacher writing on the board
24
c. Playground - boy dribbling a ball
d. Market - mother buying vegetables

24. Participates in role play

Note: Validate with the teacher.

If one of your classmates has no “baon”, what should

SEB-
you do?
ES-25
25. Displays sensitivity to the feelings of others

Time Ended:_______________________

Activity 5A Title: WORK OF HANDS

ITEM YE
ASSESSMENT ACTIVITY NO Actual Learner’s Response
CODE S
Time Started: __________________________________
I have here a
whole sheet of bond paper. Fold it once in any
(MSF- direction.
15)
15. Folds paper into a shape

Then, tear the paper following the fold you made.

(MSF-
16) 16. Tears papers in simple shapes

Here are pictures of a ball and a glass.

Trace the broken, straight, and curve lines.(For item

(MSF-
17-18)
17)
17.Traces broken-straight and curved lines

(MSF-
18.Traces continuous- straight and curved lines
18)
Color them.
(MSF-
19) 19. Colors objects

Cut the lines of the glass you traced and colored.

(Items 20-22)
(MSF-
20)
20 .Cuts paper in straight direction

© October 2017, Department of Education. For NTOT. Page 12 of 15

FORM D: MULTI-FACTORED ASSESSMENT TOOL (MFAT)
Activity 5A Title: WORK OF HANDS
ITEM YE
ASSESSMENT ACTIVITY NO Actual Learner’s Response
CODE S
(MSF-
21.Cuts paper in curved direction
21)

(MSF-
22. Cuts pictures within a given line
22)
Draw a house using different shapes.
(MSF-
23) 23.Draws a combination of shapes

Note: Observe whether the learner can hold a

pencil/drawing tool using a tripod grip while drawing a
(MSF- house.
24)
24. Holds pencil and a drawing tool using a tripod grip

Copy these letters (B, G and R) on your paper.

(MSF-
25) 25. Copies letters

Time Ended:_______________________

Activity 5B Title: LET’S GET PHYSICAL!

ITEM YE
ASSESSMENT ACTIVITY NO Actual Learner’s Response
CODE S
Time Started: __________________________________
Stand properly for 5 seconds.
(MSG-
1) 1. Stands with normal stance

Stand on one foot without support with your eyes

closed for 10 seconds.
(MSG-
2) 2. Stands on one foot without support for 10 seconds with
eyes closed

Stand on one foot, then tip toe.

(MSG-
3) 3. Stands on one foot and on tiptoe

Now, march in place for five seconds.

(MSG-
4) 4. Marches in place

(MSG- Note: Bring the learner to the area where the straight
5) line marking is.

Walk forward on the straight line.

© October 2017, Department of Education. For NTOT. Page 13 of 15
FORM D: MULTI-FACTORED ASSESSMENT TOOL (MFAT)
Activity 5B Title: LET’S GET PHYSICAL!
ITEM YE
ASSESSMENT ACTIVITY NO Actual Learner’s Response
CODE S

5. Walks in a straight line with correct stepping pattern,

Now, step backward. Then take three steps sideward

(R/L).
(MSG-
6) 6. Walks sideward and backwards with correct stepping
pattern

Hop in place three times.

(MSG-
7) 7. Hops in place

Note: Teacher points where to start.

(MSG- Skip three times following the line.

8)
8. Skips within a given path

Gallop five steps sideward (R/L).

(MSG-
9) 9. Gallops sideward

Show me your highest jump. How about your longest

jump.
(MSG-
10)
10. Jumps for distance and for a height

Note: Arrange the 3 chairs 1 meter away from each

other. Place the ball on the floor 1 meter away from the
last chair. Tell the learner to run passing through the
chairs without tumbling and ask him/her to pick up the
ball and back to the starting point going through the
same obstacle. Remind the learner to be careful. (Items
(MSG- 11-12)
11)
Run passing the three chairs in zigzag manner, get the
ball and run back in the same way. Be careful.

11. Runs at a given distance and picks up a ball in an

obstacle course.

Note: Stand at least 3 meters away from the learner.

(MSG- Catch the ball and throw it back to me.

12)
12. Throws and catches a ball

Kick the ball forward. This time, kick the ball

sideward (R/L).
(MSG-
13)
13. Kicks forward and sideward

Note: Bring the learner to the stairs.

(MSG- Go upstairs with one hand holding the rail, then go

14) down.

© October 2017, Department of Education. For NTOT. Page 14 of 15

FORM D: MULTI-FACTORED ASSESSMENT TOOL (MFAT)
Activity 5B Title: LET’S GET PHYSICAL!
ITEM YE
ASSESSMENT ACTIVITY NO Actual Learner’s Response
CODE S
This time, go up and down the stairs without holding
the rail.

14. Climbs upstairs and goes downstairs with one hand

holding the rail and without holding the rail.

Time Ended:_______________________

© October 2017, Department of Education. For NTOT. Page 15 of 15