Child’s Name: ______________________________ Division of Quezon

SOCIO- EMOTIONAL BoSY EoSY

Sex: _________ Date of Birth: __________________ CANDELARIA EAST DISTIRCT

DOMAIN P O R P O R Address: __________________________________

Enjoys watching activities of people or nearby Municipality of Candelaria Quezon
1
animals. Child’s Handedness: (Check Appropriate Box) Pahinga Norte Elementary School
Friendly w/ strangers but may initially show slight Right Left Not yet established
2
shyness. S.Y. 2019-2020
Plays alone but likes to be near to familiar adults Father’s Name: ______________________________
3
or brother and sister.
Occupation: _________________________________
4 Laughs or squeals aloud in play.
Educational Attainment: _______________________
5 Plays peek-a-boo (bulaga).
Mother’s Name: ______________________________
6 Rolls ball interactively with caregiver/ examiner. Early Childhood Care and
Occupation: _________________________________
7 Hugs or cuddles toys. Educational Attainment: _______________________ Development (ECCD)
Demonstrates respect for elders using “po” and
8
“opo”. SUMMARY OF ASSESSMENT
9
Shares toys with others familiar adults or brother
and sister.
Checklist
10 Imitates adults activities (e.g. cooking, washing)
BoSY EoSY
11 Identifies feelings of others. Date Assessed

Appropriately uses cultural gestures of greetings

Pupil’s Age
12 without much prompting( e.g. mano/bless, kiss, Domains RS SC RS SC
etc.)
Gross-Motor
13 Comforts playmates/siblings in distress. Fine Motor
Persists when faced with a problem or obstacle to Self-Help
14
his wants. Receptive Language Name: ______________________________________

15
Helps with family chores(e.g. wiping tables, Expressive Language Sex: ______________________________________
watering plants)
Cognitive
Curious about environment but knows when to Birthday: __________________________________
16 Socio-emotional
stop asking questions to adult.
Sum of Scaled Scores LRN: -
17 Waits for turns.
RS – Raw Score
Standard Scores
SC – Scaled Score
Asks permission to play with toys being used by
18
others. INTERPRETATION
To the Parents:
19 Defends possessions with determination. BoSY: P The Philippine Early Childhood Care and Development Checklist
(Form 2) contains knowledge, skills, and attitudes of children 3 – 5.11 years
Plays organized group games fairly(e.g. does not
A R old. This may be used as a guide in knowing your child and consequently give
20 E
cheat in order to win). appropriate care and teaching to guide their growth and development.
Can talk about difficult feelings (e.g. anger, NT’S SIGNATURE
21
sadness, worry) he experience.
Honors a simple bargain with caregiver (e.g., can INTERPRETATION
22
play outside only after cleaning/fixing his room) EoSY:
Watches responsibly over younger siblings/family
23
members. ______________________ _______________________
Cooperates with adults and peers in group GERRY A. GRIMALDO CECILLE M. DE GUZMAN
24
situations to minimize quarrels and conflicts. Principal II Teacher I

Total Score
PARENT’S SIGNATURE BoSY EoSY
GROSS MOTOR DOMAIN P O R P O R
Department of Education
PUPIL’S SOCIO-DEMOGRAPHIC PROFILE Region IVA-CALABARZON Climbs on chair or elevated piece of furniture like a
1
bed without help
2 Walks backward. Prepares meals for younger siblings/ family 1 Looks at direction of fallen object
13
members when no adult is around. 2 Looks for partially hidden object
3 Runs without tripping or falling.
14 Participates when being dressed.
Walks down stairs, 2 feet on each step, with one 3 Imitates behavior just seen a few minutes earlier
4 15 Pulls down gartered short pants.
hand held. 4 Offers object but will not release it
Walks upstairs holding handrail, 2 feet on each 16 Removes sando.
5 5 Looks for completely hidden object
step. Dresses without assistance except buttons and
Walks upstairs with alternate feet without holding 17 6 Exhibits simple pretend play (feed, put doll to sleep)
6 tying.
handrail. Dresses without assistance including buttons and 7 Matches objects
Walks downstairs with alternate feet without 18
7 tying. 8 Matches 2 – 3 colors
holding handrail. Informs the adult only after he has already
8 Moves body part as directed. 19 urinated (peed) or moved his bowels (pooped) in 9 Matches pictures
9 Jumps up his underpants. Sorts objects based on 2 attributes (e.g., size and
10
Informs adult of need to urinate (pee) or move color)
10 Throws ball overhead with direction. 20 bowels (poop) so he can be brought to a Sorts objects based on 2 attributes (e.g.,shape and
11
11 Hops 1 to 3 steps on preferred foot. designated place (e.g. comfort room) color)
12 Jumps and turns. Goes to the designated place to urinate (pee) or Arranges objects according to size from smallest to
12
21 move bowels (poop) but sometimes still does this biggest
13 Dances patterns/joins group movement activities. in his underpants. 13 Names 4 – 6 colors
Total Score Goes to the designated place to urinate (pee) or
14 Copies shapes
22 move bowels (poop) and never does this in his
underpants anymore 15 Names 3 animals or vegetables when asked
23 Wipes/Cleans self after a bowel movement (poop) 16 States what common household items are used for
BoSY EoSY Participates when bathing (e.g. rubbing arms with Can assemble simple puzzles
FINE MOTOR DOMAIN P O R P O R
24
soap)
17
Demonstrates an understanding of opposites by
Uses all five fingers to get food/toys placed on flat 25 Washes and dries hands without any help. 18 completing a statement (e.g., Ang aso ay malaki,
1
surface. 26 Washes face without any help. ang daga ay _____”)
2 Picks up objects with thumb and index finger. 19 Points to left and right sides of body
27 Bathes without any help.
3 Displays a definite hand preference. Can state what is silly or wrong with pictures (e.g.
Total Score 20
Ano ang mali sa larawang ito?)
4 Puts small objects in/out of containers.
2
Holds crayon with all fingers of his hand making a Matches upper and lower case letters
5 BoSY EoSY 1
fist (i.e. palmar grasp) RECEPTIVE LANGUAGE P O R P O R Total Score
6 Unscrews lid of container or unwraps food.
7 Scribbles spontaneously. 1 Points to family member when asked to do so
8 Scribbles vertical and horizontal lines. Points to 5 body parts on himself when asked to do P- Present
2
so
9 Draws circle purposely.
Points to 5 named pictured objects when asked to
O-Observed
Draws a human figure (head, eyes, trunk, arms, 3
10
hands/fingers) do so R- Reported by parent/guardian
Follows one-step instructions that include simple
11 Draws a house using geometric forms. 4
prepositions (e.g., in, on, under, etc.)
Total Score Follows 2-step instructions that include simple
5
prepositions
Total Score
BoSY EoSY
SELF HELP DOMAIN P O R P O R
Feeds self with finger foods (e.g. biscuits, bread) BoSY EoSY
1
using fingers. EXPRESSIVE LANGUAGE P O R P O R
2 Feeds self using fingers with spillage. 1 Uses 5-20 recognizable words
3 Feeds self using spoon with spillage. 2 Uses pronouns (e.g. I, me, ako, akin)
4 Feeds self using fingers without spillage. Uses 2-3 words verb-noun combinations (e.g. hingi
3
5 Feeds self using spoon without spillage. gatas)
Eats without need for spoon feeding during any 4 Names objects in pictures
6 meal. 5 Speaks in grammatically correct 2-3 word sentences
7 Helps hold cup for drinking. 6 Asks “what” questions
8 Drinks from cup with spillage. 7 Asks “who”' and “why” questions
9 Drinks from cup unassisted. Gives account of recent experiences (with prompting)
8
in order of occurrence using past tense
10 Gets drink for self unassisted.
Total Score
11 Pours from pitcher without spillage.
12 Prepares own food/snacks. BoSY EoSY
COGNITIVE DOMAIN P O R P O R