The Checklist is divided in 7 DOMAINS : Gross Motor (13 ), Fine Motor (11 ), BoSY EoSY P O R P O R

Self Help ( 27 ), Receptive Language ( 5 ), Expressive Language ( 8 ), Cognitive 1 Points to family members when asked to do so
( 21 ), Social Emotional ( 24 ). Points to 5 body parts on himself when asked to do
SELF HELP DOMAIN (Feeding sub domain) P O R P O R 2
so
The Phillipne Early Childhood Checklist will be administred twice a year Points to 5 names pictured objects when asked to
Feeds self with finger food (e.g. biscuits, bread 3
1) Beginning of School Year - BoSY. 1 do so
using fingers)
2) End of School Year - EoSY. Follows one-step instructions that include simple
Feeds self using fingers to eat rice / viands with 4
BoSY EoSY 2 prepositions (e.g. in, on, etc.)
GROSS MOTOR DOMAIN spillage
P OR P O R Follows 2-step instructions that include simple
3 Feeds self using spoon with spillage 5
Climbs on chair or other elevated piece of furniture like prepositions
1 4 Feeds self using fingers without spillage
a bed without a help Total Score
2 Walks backwards 5 Feeds self using spoon without spillage
3 Runs without tripping or falling Eats without need for spoon feeding during any BoSY EoSY
6 EXPRESSIVE LANGUAGE DOMAIN
meal P OR P O R
Walks downstairs, 2 feet on each step, with one hand 1 Uses 5-20 recognizable words
4 7 Helps hold cup for drinking
held.
8 Drinks from cup with spillage 2 Uses pronoun (e.g. I, me, ako, akin)
5 Walks upstairs holding hand trail, 2 feet on each step
9 Drinks from cup unassisted Uses 2-3 words verb – noun combinations (e.g.
Walks upstairs with alternate feet without holding hand 3
6 10 Gets drink for self unassisted hingi gatas)
trail
11 Pour from pitcher without spillage 4 Names objects in picture
Walks downstairs with alternate feet without holding
7 12 Prepare own food / snack Speaks in grammatically correct 2-3 word
hand trail 5
Prepares meals for younger siblings / family sentences
8 Moves body part as directed 13
members when no adult is around 6 Ask ” what” questions
9 Jumps up
SELF HELP DOMAIN (Dressing sub - domain) P O R P O R 7 Ask “who and “why” questions
10 Throws ball overhead with direction
Participates when being dressed (e.g. raises Give account of recent experiences (with
11 Hops 1 to 3 steps on preferred foot 14 8
arms or lifts leg) prompting) in order of occurrence using past tense
12 Jumps and turns 15 Pull down gartered shorts pants Total Score
13 Dances patterns / joins group movement activities 16 Remove sando
Dresses without assistance except for buttons
Total Score 17 BoSY EoSY
and tying COGNITIVE DOMAIN
Dresses without assistance including buttons and P O R P O R
18
tying 1 Looks at direction of fallen objects
BoSY EoSY SELF HELP DOMAIN (Toilet Training sub - domain) Looks for partially hidden objects (hide a partially
FINE MOTOR DOMAIN Informs the adult only after he has already 2
hidden objects)
P OR P O R 19 urinated (peed) or moved his bowels (poohed) in 3 Imitates behavior just seen a few minutes earlier
Uses all 5 fingers to get food / toys placed on flat his underpants 4 Offers objects but will not release it
1
surface Informs adult of need to urinate (pee) or move 5 Looks for completely hidden objects
2 Picks up objects with thumb and index finger 20 bowels (pooh-pooh) so he can be brought to a Exhibits simple pretend play (feed put doll to
designated place (e.g. comfort room) 6
sleep)
3 Displays a definite hand preference Goes to the designated place to urinate or moved
21 7 Matches objects
4 Puts small objects in/out of containers bowels but sometimes still does this in his pants 8 Matches 2-3 colors
Goes to the designated place to urinate or move 9 Matches picture
Holds crayon with all fingers of all his hand making a
5 22 bowels and never does this in his underpants 10 Sorts based on objects
fist (i.e, palmar grasp)
anymore
Sorts objects based on 2 attributes (e.g size and
6 Unscrews lid of containers or unwraps food 11
23 Wipes / cleans self after a bowel movement color)
7 Scribbles spontaneously Arranges objects according to size from smallest
SELF HELP DOMAIN (Bathing sub - domain) P 0 R P O R 12
to biggest
Scribbles vertical and horizontal lines Participates when bathing (e.g. rubbing arms with
8 24 13 Names 4-6 colors
soap)
9 Draw circle purposely 14 Copies shapes
25 Washes and dries hand without any help
Draws a human figure (head, eyes, trunk, arms, 15 Names 3 animals or vegetables when asked
10 26 Washes face without help
hands / fingers) States what common households items are used
27 Bathes without help 16
for
11 Draws a house using geometric forms 17
Total Score Can assemble simple puzzles
Total Score
SELF HELP DOMAIN RECEPTIVE LANGUAGE DOMAIN BoSY EoSY
 Demonstrates an understanding of opposites by Can talk about difficult feeling (e.g. anger,
18 completing a statements (e.g. ang aso ay malaki, 21
sadness, worry he experiences)
ang daga ay________). Republic of the Philippines
19 Points to left and right side of the body Honors a simple bargain with caregiver (e.g. can Department of Education
Can state what is silly or wrong with picture (e.g. 22 play outside only after cleaning / finishing his
20 Region
ano ang mali sa larawang ito) room)
21 Matches upper and lower case letters
Watches responsibly over younger siblings /
Division of
23
Total Score family members District of
Cooperates with adults and peers in group
ELEMENTARY SCHOOL
BoSY EoSY 24 SY 2019 – 2020
SOCIAL EMOTIONAL DOMAIN situations to minimize quarrels and conflict
P O R P O R
Total Score PHILIPPINE EARLY CHILDHOOD
Enjoys watching activities of nearby people or DEVELOPMENT CHECKLIST
1
animals CHILD’S RECORD FORM 2
ECD Summary Report 3.1 – 5.11 Years Old
Friendly with strangers but initially may show
2
slight anxiety or shyness BoSY EoSY
Date Tested Sociodemographic Profile
Plays alone but likes to be near familiar adults or
3 Pupil’s Age
brothers or sisters
Raw Scale Raw Scale LRN : _________________
4 Laughs or squeals aloud in play DOMAINS Score Score Score Score
5 Plays peek-a-boo Gross-Motor CHILD’S NAME:
Fine Motor Last Name First Name M.I.
6 Rolls ball interactively with caregiver / examiner
Self-Help Date of Birth:____________ Age: _____ Sex: _____
7 Hugs or cuddles toys month/day/year y/m M/F
Receptive Language
Demonstrates respect for elders using terms like Address
8 Expressive Language
“po” and “opo” Barangay Municipality Province
Cognitive
9 Shares toys with others
Socio-emotional
10 Imitates adult activities (e.g. cooking, washing) Child’s Handedness
Sum of Scaled Scores   Right   left
(Check Appropriate Box)
11 Identifies feelings in others Standard Scores Both   Not yet Established
Appropriately uses cultural gestures of greetings
12 without much prompting (e.g. mano, bless,kiss, INTERPRETATION Is the child presently studying?
etc)
BoSY: (Check Appropriate Box)   Yes   no
13 Comforts playmates / siblings in distress
Persist when faced with a problem or obstacle to Father's Name: Age:
14
his wants Father's Occupation:
________________________________
Helps with family chores (e.g. wiping tables, Parent/Guardian’s Signature Educational Attainment: ________________________________
15
watering plants, etc.) Mother's Name: Age:
EoSY:
Curious about environment but knows when to Mother's Occupation:
16
stop asking questions of adults Educational Attainment: ________________________________
17 Waits for turn Child's Number of Siblings: Child's Birth Order:
________________________________
Asks permission to play with toy being used by Parent/Guardian’s Signature
18 To the Parent:
another
The Philippine Early Childhood Development Checklist contains
19 Depends possessions with determination knowledge, skills, attitudes of children 3.2 to 5.1 y/o. This may be used as a
Plays organized group games fairly (e.g. does guide in knowing your child and consequently give appropriate care and
20 teaching to guide their growth and development.
not cheat in order to win)

________________________ __________________________
Teacher Principal