SOCIO- EMOTIONAL DOMAIN BoSY EoSY Child’s Name: ______________________________ Region IV-A (CALABARZON)
Sex:_________ Date of Birth:__________________ Division of Cavite
PRE POST
Address: __________________________________ Trece Martires ity
1 Enjoys watching activities of people or nearby animals.
Child’s Handedness: (Check Appropriate Box) SAINT GAETANO CATANOSO SCHOOL INC.
2 Friendly w/ strangers but may initially show slight shyness. Right Left Not yet established
Ilayang Pulo, Iba Silang Cavite
3 Plays alone but likes to be near to familiar adults or brother and sister.
Father’s Name: ___________________________________ Affiliated with Saint Veronica Learning Center Inc
4 Laughs or squeals aloud in play. Occupation:_____________________________________ Bantug St., Tagnipa, Maasin City
5 Plays peek-a-boo (bulaga). Educational Attainment: ____________________________
Mother’s Name:___________________________________
6 Rolls ball interactively with caregiver/ examiner.
Occupation:____________________________________ Kindergarten
7 Hugs or cuddles toys.
Educational Attainment: _______________________ SY: 2021-2022
8 Demonstrates respect for elders using “po” and “opo”.
9 Shares toys with others familiar adults or brother and sister.
SUMMARY OF ASSESMENT Philippine
Early Childhood Development (ECD)
10 Imitates adults activities (e.g. cooking, washing)
11 Identifies feelings of others.
BoSY EoSY
Appropriately uses cultural gestures of greetings without much Date Assessed
12
prompting( e.g. mano/bless, kiss, etc.) Pupil’s Age
13 Comforts playmates/siblings in distress. Domains RS SC RS SC
Gross-Motor
14 Persists when faced with a problem or obstacle to his wants. Fine Motor Name : __________________________
Self-Help
15 Helps with family chores(e.g. wiping tables, watering plants)
Receptive Language
Sex : __________________
16
Curious about environment but knows when to stop asking questions Expressive Language Birthday : __________________
to adult.
Cognitive
LRN: -
17 Waits for turns. Socio-emotional
Sum of Scaled Scores
18 Asks permission to play with toys being used by others.
Standard Scores To the Parents:
19 Defends possessions with determination. INTERPRETATION The Philippine Early Childhood Care and Development Checklist
(Form 2) contain knowledge, skills, and attitudes of children 3 – 5.11 years
Plays organized group games fairly(e.g. does not cheat in order to BoSY: old. This may be used as a guide in knowing your child and consequently give
20 appropriate care and teaching to guide their growth and development.
win).
Can talk about difficult feelings (e.g. anger, sadness, worry) he
21
experience.
Honors a simple bargain with caregiver (e.g., can play outside only
22
after cleaning/fixing his room)
PARENT’S SIGNATURE
RUSIEL G. LASTRA
23 Watches responsibly over younger siblings/family members. EoSY: Teacher
Cooperates with adults and peers in group situations to minimize RECCA GORNE-SUMAYA
24
quarrels and conflicts.
School Head
PARENT’S SIGNATURE
Total Score
GROSS MOTOR DOMAIN BoSY EoSY
PUPIL’S SOCIO-DEMOGRAPHIC PROFILE Republic of the Philippines PRE POST
Department of Education 1 Climbs on chair or elevated piece of furniture like a bed without help
2 Walks backward. Total Score 5 Speaks in grammatically correct 2-3 word sentences
3 Runs without tripping or falling. 1 Pours from pitcher without spillage. 6 Asks “what” questions
4 Walks down stairs, 2 feet on each step, with one hand held. 1 7 Asks “who”' and “why” questions
5 Walks upstairs holding handrail, 2 feet on each step. 1 Prepares own food/snacks.
2 8 Gives account of recent experiences (with prompting) in order of
6 Walks upstairs with alternate feet without holding handrail. 1 Prepares meals for younger siblings/ family members when no occurrence using past tense
7 Walks downstairs with alternate feet without holding handrail. 3 adult is around. Total Score
8 Moves body part as directed. 1 Participates when being dressed.
4 COGNITIVE DOMAIN BoSY EoSY
9 Jumps up 1 Pulls down gartered short pants. PRE POST
1 5 1 Looks at direction of fallen object
Throws ball overhead with direction. 1 Removes sando.
0 2 Looks for partially hidden object
6
1 1 Dresses without assistance except buttons and tying.
3 Imitates behavior just seen a few minutes earlier
Hops 1 to 3 steps on preferred foot.
1 7 4 Offers object but will not release it
1 1 Dresses without assistance including buttons and tying. 5 Looks for completely hidden object
Jumps and turns.
2 8
1 Informs the adult only after he has already urinated (peed) or 6 Exhibits simple pretend play (feed, put doll to sleep)
1
Dances patterns/joins group movement activities. 9 moved his bowels (pooped) in his underpants. 7 Matches objects
3
2 Informs adult of need to urinate (pee) or move bowels (poop) so 8 Matches 2 – 3 colors
Total Score 0 he can be brought to a designated place (e.g. comfort room)
2 Goes to the designated place to urinate (pee) or move bowels 9 Matches pictures
1 (poop) but sometimes still does this in his underpants. 10 Sorts objects based on 2 attributes (e.g., size and color)
EoS 2 Goes to the designated place to urinate (pee) or move bowels
11 Sorts objects based on 2 attributes (e.g.,shape and color)
BoSY 2 (poop) and never does this in his underpants anymore
FINE MOTOR DOMAIN Y 2 Wipes/Cleans self after a bowel movement (poop) 12 Arranges objects according to size from smallest to biggest
PRE POST 3 13 Names 4 – 6 colors
1 Uses all five fingers to get food/toys placed on flat surface. 2 Participates when bathing (e.g. rubbing arms with soap)
14 Copies shapes
4
2 Picks up objects with thumb and index finger. 15 Names 3 animals or vegetables when asked
2 Washes and dries hands without any help.
3 Displays a definite hand preference. 5 16 States what common household items are used for
2 Washes face without any help.
4 Puts small objects in/out of containers. 17 Can assemble simple puzzles
6
5 Holds crayon with all fingers of his hand making a fist (i.e. palmar grasp) 2 Bathes without any help. 18 Demonstrates an understanding of opposites by completing
7 a statement (e.g., Angaso ay malaki, angdaga ay _____”)
6 Unscrews lid of container or unwraps food.
Total Score 19 Points to left and right sides of body
7 Scribbles spontaneously.
8 Scribbles vertical and horizontal lines. 20 Can state what is silly or wrong with pictures (e.g.
Anoangmalisalarawangito?)
9 Draws circle purposely.
2 Matches upper and lower case letters
10 Draws a human figure (head, eyes, trunk, arms, hands/fingers) BoSY EoSY 1
11 Draws a house using geometric forms. RECEPTIVE LANGUAGE PRE POST Total Score
Total Score 1 Points to family member when asked to do so
2 Points to 5 body parts on himself when asked to do so P- Present
3 Points to 5 named pictured objects when asked to do so O-Observed
SELF HELP DOMAIN EoS R- Reported by parent/guardian
BoSY 4 Follows one-step instructions that include simple prepositions
Y (e.g., in, on, under, etc.)
PRE POST 5 Follows 2-step instructions that include simple prepositions
1 Feeds self with finger foods (e.g. biscuits, bread) using fingers.
2 Total Score
Feeds self using fingers with spillage.
3 Feeds self using spoon with spillage.
4 Feeds self using fingers without spillage. BoSY EoSY
EXPRESSIVE LANGUAGE PRE POST
5 Feeds self using spoon without spillage.
1 Uses 5-20 recognizable words
6 Eats without need for spoon feeding during any meal.
7 2 Uses pronouns (e.g. I, me, ako, akin)
Helps hold cup for drinking.
8 Drinks from cup with spillage. 3 Uses 2-3 words verb-noun combinations (e.g. hingigatas)
9 Drinks from cup unassisted.
4 Names objects in pictures
10 Gets drink for self unassisted.
