UNIVERSITY OF SANTO TOMAS

COLLEGE OF EDUCATION
ELEMENTARY EDUCATION DEPARTMENT

DEVELOPMENTAL CHECKLIST

Observer: Cooperating School:

Child’s Name (Initials only): Child’s Date of Birth:
Grade Level: Diagnosis (if known):

MOVEMENT/ PHYSICAL DEVELOPMENT

OBSERVATION OBJECTIVES: *input focus area in this developmental area
MILESTONE 1ST 2ND 3RD
OBSERVATI OBSERVATI OBSERVATI
ON ON ON
MM/DD/YY MM/DD/YY MM/DD/YY

*Insert milestones for this area in NO / A / M

this column. Add or remove rows as
needed.

INDICATORS: NO – Not Observed, A- Attempted, M-Mastered

OBSERVATION NOTES
1ST OBSERVATION
• Bullet form the statements that would justify the indicators for the skills.
2ND OBSERVATION
• Bullet form the statements that would justify the indicators for the skills.

3RD OBSERVATION
• Bullet form the statements that would justify
the indicators for the skills.
UNIVERSITY OF SANTO
TOMAS
COLLEGE OF
EDUCATION
ELEMENTARY EDUCATION DEPARTMENT

COGNITIVE
OBSERVATION OBJECTIVES: *input focus area in this developmental area
MILESTONE 1ST 2ND 3RD
OBSERVATI OBSERVATI OBSERVATI
ON ON ON
MM/DD/YY MM/DD/YY MM/DD/YY

*insert milestones for this area in this NO / A / M

column. Add or remove rows as needed.

INDICATORS: NO – Not Observed, A- Attempted, M-Mastered

OBSERVATION NOTES
1ST OBSERVATION
• Bullet form the statements that would justify the indicators for the skills.
2ND OBSERVATION
• Bullet form the statements that would justify the indicators for the skills.

3RD OBSERVATION
• Bullet form the statements that would justify
the indicators for the skills.
UNIVERSITY OF SANTO
TOMAS
COLLEGE OF
EDUCATION
ELEMENTARY EDUCATION DEPARTMENT

SOCIAL AND EMOTIONAL

OBSERVATION OBJECTIVES: *input focus area in this developmental area
MILESTONE 1ST 2ND 3RD
OBSERVATI OBSERVATI OBSERVATI
ON ON ON
MM/DD/YY MM/DD/YY MM/DD/YY

*insert milestones for this area in this NO / A/ M

column. Add or remove rows as needed.

INDICATORS: NO – Not Observed, A- Attempted, M-Mastered

OBSERVATION NOTES
1ST OBSERVATION
• Bullet form the statements that would justify the indicators for the skills.

2ND OBSERVATION
• Bullet form the statements that would justify the indicators for the skills.

3RD OBSERVATION
• Bullet form the statements that would justify
the indicators for the skills.
UNIVERSITY OF SANTO
TOMAS
COLLEGE OF
EDUCATION
ELEMENTARY EDUCATION DEPARTMENT

LANGUAGE/COMMUNICATION
OBSERVATION OBJECTIVES: *input focus area in this developmental area
MILESTONE 1ST 2ND 3RD
OBSERVATI OBSERVATI OBSERVATI
ON ON ON
MM/DD/YY MM/DD/YY MM/DD/YY

*insert milestones for this area in this NO / A / M

column. Add or remove rows as needed.
INDICATORS: NO – Not Observed, A- Attempted, M-Mastered

OBSERVATION NOTES
1ST OBSERVATION
• Bullet form the statements that would justify the indicators for the skills.

2ND OBSERVATION
• Bullet form the statements that would justify the indicators for the skills.

3RD OBSERVATION
• Bullet form the statements that would justify the indicators for the skills.

CONCLUSION
Based on your observations, would you define the child’s development typical or atypical?
Why?
RECOMMENDATION
Are there areas that the child needs more support? What are your recommendations for the
parent/Teacher/ to supplement their child’s
development?
UNIVERSITY OF SANTO
TOMAS
COLLEGE OF
EDUCATION
ELEMENTARY EDUCATION DEPARTMENT

References: