Department of Education
Region V Bicol
Division of Catanduanes
Virac South District
SEX:
MALE
FEMALE
LRN: 0
LEFT
RIGHT
UNESTABLISHED
BIRTH DATE:
AGE:
GRADE LEVEL:
KINDERGARTEN
AS OF:
CHILDS
ADDRESS:
CHILDS
FATHERS
EDUCATIONAL
CIVIL
FATHER:
ATTAINMENT:
OCCUPATION:
AGE:
STATUS:
CUSTODIAL
PARENT:
CHILDS
MOTHERS
EDUCATIONAL
CIVIL
MOTHER:
YES /
NO
AGE:
ATTAINMENT:
STATUS:
OCCUPATION:
CUSTODIAL
YES
PARENT:
AGE OF MOTHER WHEN
ND
GUARDIAN (IF
RD
NO
ST
OTHERS: ___
RELATIONSHIP:
APPLICABLE):
__________________
TO THE PARENTS:
The Philippine Early Childhood Development Checklist (Form 2) contains
knowledge, skills and attitudes of children 3 5.11 years old. This may be
used as a guide in knowing your child and consequently give appropriate care
and teaching to guide their growth and development.
CONTENT:
Every page contains different domains of development with their
corresponding total scores:
- Gross Motor Domain has - Fine Motor Domain has
- Self-help Domain
13 items
11 items
has 27 items
- Receptive Language
- Expressive Language
- Cognitive Domain
Domain has 5 items
Domain has 8 items
has 21 items
- Social-Emotional Domain
has 24 items
Each item observed are recorded three times within a year:
(1) at the start of the year, (2) at the middle of the year, and (3) at the end of
the year.
COLUMNS
P Present or the child can do the
O Observed or the child was
R Report given by the
-
__________________________
ADVISER
GROSS MOTOR DOMAIN
A 3.1 4.0
M
M
M
SCORE
Present or child is able to do
Skill is not present or child
0 no opportunity to observe the
-
__________________________
SCHOOL PRINCIPAL I
COMME
COMM
P O R COMME
NTS P O R NTS P O R ENTS
.
Climbs on chair or other
1 elevated piece of furniture like
a bed without help
2 Walks backwards
B
4.1 5.0
.
A
3.1 4.0
.
COMME
COMM
P O R COMME
NTS P O R NTS P O R ENTS
COMME
COMM
P O R COMME
NTS P O R NTS P O R ENTS
SCALED SCORE
SELF-HELP DOMAIN
A
3.1 4.0
.
Feeds self with finger food
1 (e.g., biscuits, bread, etc.)
using fingers
COMME
COMM
P O R COMME
NTS P O R NTS P O R ENTS
Removes sando
SELF-HELP DOMAIN
1
COMME
COMM
P O R COMME
NTS P O R NTS P O R ENTS
EXPRESSIVE LANGUAGE
A
3.1 5.0
.
COMME
COMM
P O R COMME
NTS P O R NTS P O R ENTS
6 Asks whatquestions
7
A
3.1 4.0
.
COMME
COMM
P O R COMME
NTS P O R NTS P O R ENTS
COGNITIVE DOMAIN
1
COMME
COMM
P O R COMME
NTS P O R NTS P O R ENTS
3
1
4
Copies shapes
Names 3 animals or
5 vegetables when asked
1
1 Demonstrates an understanding
of opposites by completing a
8 statement (e.g., Ang aso ay
malaki, ang daga _____)
1
SOCIAL-EMOTIONAL DOMAIN
A
3.1 5.0
.
COMME
COMM
P O R COMME
NTS P O R NTS P O R ENTS
1 Comforts playmates/siblings in
3 distress
when faced with a
1 Persists
problem
4 wants or obstacle to his
COMME
COMM
P O R COMME
NTS P O R NTS P O R ENTS
PR
E
TOTA
L
SCAL
ED
MID TOTA
L
SCAL
GROSS
MOTOR
DOMAIN
FINE
MOTOR
DOMAIN
RECEPTIV EXPRESSI
SOCIOVE
SELF-HELP
E
COGNITIVE EMOTIONA
DOMAIN
LANGUAGE LANGUAGE
DOMAIN
L DOMAIN
DOMAIN
DOMAIN
ED
PO
ST
TOTA
L
SCAL
ED
ASSESSMENT
PRE: ___ /
___ / _____
MID: ___ /
___ / _____
POST: ___ /
___ / _____
COMMENTS
EXAMINERS /
TEACHERS
NAME AND
SIGNATURE
PARENTS /
CAREGIVERS
NAME AND
SIGNATURE