NUMBER OF DAYS IN ATTENDANCE ___________________________ _________________________

No. of June July Aug Sept Oct Nov Dec Jan Feb Mar Apr Total Department of Education
Days Region IX, Zamboanga Peninsula
Division of Zamboanga City
No. of Baliwasan District
Days BALIWASAN CENTRAL SCHOOL SPED CENTER
Present Zamboanga City
No. of
Days
Absent EARLY CHILDHOOD CARE and DEVELOPMENT
No. of CHECKLIST FOR KINDERGARTEN
Days (REVISED ECCD FORM 2)
Tardy
School Year: 2017 - 2018

CERTIFICATE OF COMPLETION

This is to certify that _____________________________________

has completed the Kindergarten Curriculum as prescribed by the

Department of Education School year 2017-2018.

Noted

LRN No.: ____________________

ELOWIZA R. GARCIA EDGARDO A. FALCATAN, EdD.

Kindergarten Teacher Elementary School Principal III Child’s Name: ___________________________________________

Date of Birth: _________________ Age: ___ as of JUNE Sex: ____

ELIGIBILITY TO TRANSFER

Eligible to transfer and admission to ______________________

 20. Plays organized group games fairly
(e.g., does not cheat in order to win) 1st Assessment 2nd Assessment
21. Can talk about difficult feelings (e.g., Domains Raw Score Scale Score Raw Score Scale Score
anger, sadness, worry) being Gross-Motor
experienced Fine Motor
22. Honors a simple bargain with
Self-Help
caregiver (e.g., can play outside
only after cleaning / finishing his room) Receptive Language
23. Watches responsibly over younger Expressive Language
siblings/family members Cognitive
24. Cooperates with adults and peers in Socio-Emotional
group situations to minimize quarrels Raw Score
and conflicts Scaled Score
-
Standard Score
TOTAL SCORE - Date Tested

-Self-help Domain-Respective
has 27 items -Social-Emotional
Language Domain has 24 items
Domain has 2 items
Interpretation Parent’s Signature
Each item observed are recorded three times within a year: 1) at the start of the year: 2) at the end
of the year.
1st Assessment:________________________________ _______________________
Legend of the Comment
________________________________
A Item is not applicable
B Lack of opportunity
2nd Assessment:________________________________ ______________________
C Response was not display 2 and 3 trials
________________________________
INTERPRETATION OF STANDARD SCORE OR DEVELOPMENT INDEX
STANDARD SCORE
Suggest significant delay in overall
69 AND BELOW development
70-79 Suggest slight delay in overall
development
80-119 Average overall development
120-129 Suggests slightly advanced development
130-above Suggests highly advanced development

Name of Examiner: ________________________________________________

EARLY CHILDHOOD DEVELOPMENT CHECKLIST FOR
Date of Administered: ______________________________________________
KINDERGARTEN
-10-
Place where test is administered: ____________________________________
To Examine;
Please fill out the spaces below for additional information. Thank you very
EARLY CHILDHOOD DEVELOPMENT CHECKLIST FOR
SUMMARY OF ASSESSMENT
KINDERGARTEN much. Write down your notes, descriptions and observations on the following
-1- points:
Child’s background (ex. Behavior/health/ect.) ___________________________
_________________________________________________________________
Family environment (ex. Health of Family members/family problems/economic
 Mother’s Occupation: ___________Mother’s Educational Attainment:_________

The Checklist should be administered to the child twice in a school year.

Instructions are provided in filling out each table.

COMPUTATION OF CHILD'S AGE

Year Month Day Examiner's
Name
Date Tested
1st Assessment Child’s Date of Birth
Child’s Age
Date Tested
2nd Assessment Child’s Date of Birth
Child’s Age

EARLY CHILDHOOD DEVELOPMENT CHECKLIST FOR

KINDERGARTEN

SOCIODEMOGRAPHIC
EARLY CHILDHOOD PROFILE
DEVELOPMENT CHECKLIST FOR -2-
KINDERGARTEN
-9-
Child's Name:________________________________________________________

Date of Birth:___________/__________/_______ Age: ________ Sex:________

Month Day Year

Barangay: ___________________Municipality/City: _____________________

Province: ____________________________Region: _______________________

Child's Handedness: (check appropriate box) right left

Both Not yet established

Is the child presently studying? (check appropriate box) Yes No

If yes, write name of child's school / learning center / day care? Yes No
_____________________________________________

Father's Name: ________________________________________Father's Age: _______

Father's Occupation: _____________ Father's Educational Attainment:_________

Mother's Name:______________________________________ Mother’s Age: _______

 DOMAIN
GROSS MOTOR
1. Climbs on chair or other elevated
piece of furniture like a bed without
help
2. Walks backwards
3. Runs without tripping falling
4. Walk down stairs, 2 feet on each
step, with one hand held
5. Walks upstairs holding handrail, 2
feet on each step
6. Walks upstairs with alternate feet
without holding handrail
7. Walks downstairs with alternate feet
holding handrail
8. Moves body parts as directed.
9. Jumps up
10. Throws ball overhead with direction
11. Hops 1 to 3 steps on preferred
foot
12. Jumps and turns
13. Dances patterns/joins group
movement activities
TOTAL SCORE
FINE MOTOR
1. Uses all 5 fingers to get foot/toys
placed on flat surface
2. Picks up objects with thumb and
index finger
3.Displays a definite hand preference
4.Puts small objects in/out of containers
5.Holds crayon with all the fingers of
his hand making a fist
6.Unscrews lid of container or unwraps
food
7. Scribbles spontaneously
8. Scribbles vertical and horizontal lines
EARLY CHILDHOOD DEVELOPMENT CHECKLIST FOR
KINDERGARTEN
ASSESSMENT SOCIO-EMOTIONAL 1ST Comments 2ND Comments
1ST
Comments 2ND Comments 1. Enjoys watching activities of
nearby people or animals
2. Friendly with strangers but
initially may show slight anxiety
or shyness
3. Plays alone but likes to be near
familiar adults or brothers and
sisters
4. Laughs or squeals aloud in play
5. Plays peek-a-boo (bulaga)
6. Rolls ball interactively with
caregiver/examiner
7. Hugs or cuddles toys
8. Demonstrates respect for elders
using terms “po” and “opo”
9. Shares toys with others
10. Imitates adult activities (e.g.,
cooking , washing)
11. Identifies feelings in other
12. Appropriately uses cultural
gestures of greeting without
much prompting (e.g., mano,
bless, kiss, etc.)
13. Comforts playmates/sibling in
distress
14. Persists when faced with a
problem or obstacle to his
wants
15. Helps with family chores (e.g.,
wiping table, watering plants
etc.)
16. Curious about environment but
knows when to stop asking
questions of adults
17. Waits for turn
18. Asks permission to play with
toy being used by another
19. Defends possessions with
determination
EARLY CHILDHOOD DEVELOPMENT CHECKLIST FOR
KINDERGARTEN
-3- -8-
COGNITIVE EARLY CHILDHOOD DEVELOPMENT CHECKLIST FOR
1ST Comments 2ND Comments 1.Draws circle purposely
KINDERGARTEN
1. Looks at direction of fallen object 2. Draws a human figure ( head,
eyes, trunk, arms, hands/fingers)
-7-
2. Imitates behavior just seen a few
minutes earlier
3. Offers object but will not release it 3.Draws a house using geometric
4. Looks for completely hidden object forms
5. Exhibits simple pretend play (red, put
doll to sleep)
TOTAL SCORE
6. Matches objects
7. Matches 2-3 colors
8. Matches pictures
SELF-HELP 1ST Comments 2ND Comments
9. Sorts based on shapes
1. Feeds self with finger food ( e.g.
10. Sorts objects based on 2 attributes
biscuits, bread) using fingers
(e.g., size and color)
11. Arranges objects according to size 2. Feeds self-using spoon with
from smallest to biggest spillage
12. Names 4-6 colors 3. Feeds self-using spoon without
13. Copies shapes spillage
14. Names 3 animals or vegetables 4. Feeds self-using fingers with
when asked spillage
15. State what common household
5. Feeds self-using fingers without
items are used for
spillage
16. Can assemble simple puzzles
17. Demonstrates an understanding of 6. Eats without need for spoon
opposite by completing a feeding during any meal
statement 7. Helps hold cup for drinking
18. Points to left and right sides of 8. Drinks from cup with spillage
body (at least 5 body parts) 9. Drinks from cup unassisted
19. Can state what is silly or wrong 10. Gets drink for self-unassisted
with pictures
20. Matches upper and lower case 11. Pours from pitcher without
letters spillage
21. Copies shapes (circle, triangle) 12. Prepares own food/snack
13. Prepares meals for younger
TOTAL SCORE siblings/family members when no
adult is around
14. Participates when being
dressed (e.g. raises arms or lifts
leg)
 EARLY CHILDHOOD DEVELOPMENT CHECKLIST FOR
15. Pulls down gartered short KINDERGARTEN
pants
15. 16. Removes sando
17. Dresses without assistance except
for buttons and tying
18. Dresses without assistance
including buttons and tying
19. Informs the adult only after he has
already urinated (peed) or moved
his bowels (poohed) in his
underpants
20. Informs adult of need to urinate
(pee) or move bowels (pooh-pooh)
so he can be brought to a
designated place
21. Goes to the designated place to
urinate (pee) or move bowels and
(pooh) but sometimes still does this
in his underpants
22. Goes to the designated place to
urinate or move bowels never does
this in his underpants anymore
23. Wipes/Cleans self after a bowel
movement (pooh)
24. Participates when bathing (e.g.
rubbing arms with soap
25. Washes and dries hands without
any help
26. Washes face without any help
27. Bathes without any help
TOTAL SCORE
EARLY CHILDHOOD DEVELOPMENT CHECKLIST FOR
KINDERGARTEN
-4- RECEPTIVE LANGUAGE -5-
1ST Comments 2ND Comments
1. Points to family member when
asked to do so
2. Points to 5 body parts on himself
when asked to do so
3. Points to 5 named pictured
objects when asked to do so
4.Follows one-step instructions that
include simple prepositions
(e.g., in, on, under, etc.)
5.Follows 2- step instructions that
include simple prepositions
TOTAL SCORE
EXPRESSIVE LANGUAGE
1ST Comments 2ND Comments
1. Uses 5-20 recognizable words
2. Uses pronouns (e.g. I, me, ako,
akin)
3. Uses 2-3 words verb-noun
combinations (e.g. hingi gatas)
4. Names objects in pictures
5. Speaks in grammatically correct
2-3 word sentences
6. Asks “what” and “why”
questions
7. Asks “who” and “why” questions
8. Gives account of recent
experiences (with prompting in
order of occurrence using past
tense)
TOTAL SCORE
EARLY CHILDHOOD DEVELOPMENT CHECKLIST FOR
KINDERGARTEN
-6-