1st Evaluation 2nd Evaluation 3rd Evaluation

Date: Age: Date: Age: Date: Age:

DOMAIN
Raw Scaled Raw Scaled Raw Scaled
Score Score Score Score Score Score

Gross Motor

Fine Motor

Self-Help

Receptive
Language

Expressive
Language

Cognitive

Social
Emotional

Sum of Scaled
Score

Standard Score

Interpretation

SCALE
 D INTERPRETATION
SCORE
1-3 Development in the domain must be monitored
after 3 months.
4-6 Development in the domain must be monitored
after 6 months.
7-13 Average over-all development in the domain.

14-16 Suggests slight, advanced development in the

domain.
17-19 Suggests highly, advanced development in the
domain.

STANDAR
D INTERPRETATION
SCORE
69 and Over-all development must be monitored
below after 3 months.
70-79 Over-all development must be monitored
after 6 months.
80-119 Average over-all development.

120-129 Slight, advanced over-all development.

130 and Highly, advanced over-all development.

above
 Republic of the Philippines
Province of Pangasinan
Municipality of Mangatarem
Dear Parents,
MUNICIPAL SOCIAL WELFARE AND DEVELOPMENT OFFICE
This ECCD Card show the ability and progress of your child based
on Seven (7) Development Domain. There is no pass or fail score. This is
only summary of ECCD Checklist. Any results we will give suggestions on
what else you can do to stimulate your child’s development. EARLY CHILDHOOD CARE AND
DEVELOPMENT CHECKLIST
PARENT/GUARDIAN’S SIGNATURE

Child Development Center

FIRST EVALUATION:___________________________________________

SECOND EVALUATION:_________________________________________

THIRD EVALUATION:__________________________________________
Child’s Name

Date of Birth(m/d/y) Age Sex

_EMMA D. DIONEDA_____
CHILD DEVELOPMENT WpORKER

Parent/Guardian’s Name

ABIGAILE P. DAMES
MSWDO ECCD Service Provider

Punong Barangay