Child’s Name: ______________________________ Maasin District I

SOCIO- EMOTIONAL DOMAIN BoSY EoSY

Sex:_________ Date of Birth:__________________
P O R P O R Address: __________________________________
Enjoys watching activities of people or nearby
MAASIN CENTRAL SCHOOL
1
animals. Child’s Handedness: (Check Appropriate Box) SY:2021-2022
2
Friendly w/ strangers but may initially show slight
shyness.
Right Left Not yet established Kindergarten
Plays alone but likes to be near to familiar adults or Father’s Name: ______________________________
3
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.
Occupation:_________________________________
7 Hugs or cuddles toys. Educational Attainment: _______________________
Demonstrates respect for elders using “po” and
8
“opo”. SUMMARY OF ASSESMENT
Shares toys with others familiar adults or brother and
9
sister.
BoSY EoSY
Name: __________________________
10 Imitates adults activities (e.g. cooking, washing)
Date Assessed Sex: __________________
11 Identifies feelings of others. Pupil’s Age
Birthday: __________________
Domains RS SC RS SC
Appropriately uses cultural gestures of greetings LRN: -
12 Gross-Motor
without much prompting( e.g. mano/bless, kiss, etc.)
Fine Motor
13 Comforts playmates/siblings in distress.
Self-Help
Persists when faced with a problem or obstacle to his Receptive Language To the Parents:
14
wants. The Philippine Early Childhood Care and Development Checklist
Expressive Language
Helps with family chores(e.g. wiping tables, watering (Form 2) contains knowledge, skills, and attitudes of children 3 – 5.11 years
15 Cognitive old. This may be used as a guide in knowing your child and consequently give
plants)
appropriate care and teaching to guide their growth and development.
Curious about environment but knows when to stop Socio-emotional
16
asking questions to adult. Sum of Scaled Scores
17 Waits for turns. Standard Scores
RS – Raw Score
SC – Scaled
18
Asks permission to play with toys being used by
Score ALMERA G.COSTILLAS
others.
Teacher
INTERPRETATION
19 Defends possessions with determination.
MAIRASOL M.MANLIMOS
Plays organized group games fairly(e.g. does not
BoSY: Principal Ii
20
cheat in order to win).
Can talk about difficult feelings (e.g. anger, sadness,
21
worry) he experience. PARENT’S SIGNATURE
Honors a simple bargain with caregiver (e.g., can
22
play outside only after cleaning/fixing his room) EoSY:
Watches responsibly over younger siblings/family
23
members.

24
Cooperates with adults and peers in group situations PARENT’S SIGNATURE
to minimize quarrels and conflicts.

Total Score Republic of the Philippines GROSS MOTOR DOMAIN BoSY EoSY
P O R P O R
Department of Education 1 Climbs on chair or elevated piece of furniture like a
bed without help
PUPIL’S SOCIO-DEMOGRAPHIC PROFILE Schools Division of Maasin City 2 Walks backward.
3 Runs without tripping or falling. 12 Prepares own food/snacks. 1 Looks at direction of fallen object
2 Looks for partially hidden object
4 Walks down stairs, 2 feet on each step, with one 13 Prepares meals for younger siblings/ family members
hand held. when no adult is around. 3 Imitates behavior just seen a few minutes earlier
5 Walks upstairs holding handrail, 2 feet on each step. 14 Participates when being dressed. 4 Offers object but will not release it
6 Walks upstairs with alternate feet without holding 15 Pulls down gartered short pants. 5 Looks for completely hidden object
handrail. Removes sando.
16 6 Exhibits simple pretend play (feed, put doll to sleep)
7 Walks downstairs with alternate feet without holding
handrail. 17 Dresses without assistance except buttons and tying. 7 Matches objects
8 Moves body part as directed. 18 Dresses without assistance including buttons and tying. 8 Matches 2 – 3 colors
9 Jumps up Informs the adult only after he has already urinated 9 Matches pictures
19 (peed) or moved his bowels (pooped) in his
1 Throws ball overhead with direction.
10 Sorts objects based on 2 attributes (e.g., size and
underpants.
0 Informs adult of need to urinate (pee) or move bowels color)
1 Hops 1 to 3 steps on preferred foot. 20 (poop) so he can be brought to a designated place 11 Sorts objects based on 2 attributes (e.g.,shape and
1 (e.g. comfort room) color)
1 Jumps and turns. Goes to the designated place to urinate (pee) or move 12 Arranges objects according to size from smallest to
21 bowels (poop) but sometimes still does this in his biggest
2 underpants. 13 Names 4 – 6 colors
1 Dances patterns/joins group movement activities.
Goes to the designated place to urinate (pee) or move 14 Copies shapes
3 22 bowels (poop) and never does this in his underpants
Total Score 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
Participates when bathing (e.g. rubbing arms with 17 Can assemble simple puzzles
24
BoSY EoSY soap) 18 Demonstrates an understanding of opposites by
FINE MOTOR DOMAIN 25 Washes and dries hands without any help. completing a statement (e.g., Angaso ay malaki,
P O R P O R
Uses all five fingers to get food/toys placed on flat surface. 26 Washes face without any help. angdaga ay _____”)
1 19 Points to left and right sides of body
27 Bathes without any help.
2 Picks up objects with thumb and index finger.
20 Can state what is silly or wrong with pictures (e.g.
3 Displays a definite hand preference. Total Score Anoangmalisalarawangito?)
Puts small objects in/out of containers. 2 Matches upper and lower case letters
4
1
Holds crayon with all fingers of his hand making a fist (i.e.
5 Total Score
palmar grasp) BoSY EoSY
6 Unscrews lid of container or unwraps food. RECEPTIVE LANGUAGE P O R P O R
7 Scribbles spontaneously.
Scribbles vertical and horizontal lines.
1 Points to family member when asked to do so P- Present
8 2 Points to 5 body parts on himself when asked to do so
Draws circle purposely.
O-Observed
9 3 Points to 5 named pictured objects when asked to do so
Draws a human figure (head, eyes, trunk, arms, 4 Follows one-step instructions that include simple
R- Reported by parent/guardian
10 hands/fingers)
prepositions (e.g., in, on, under, etc.)
11 Draws a house using geometric forms.
5 Follows 2-step instructions that include simple
Total Score prepositions
Total Score

SELF HELP DOMAIN BoSY EoSY BoSY EoSY

EXPRESSIVE LANGUAGE P O R P O R
P O R P O R
1 Uses 5-20 recognizable words
1 Feeds self with finger foods (e.g. biscuits, bread) using
fingers. 2 Uses pronouns (e.g. I, me, ako, akin)
2 Feeds self using fingers with spillage. 3 Uses 2-3 words verb-noun combinations (e.g.
hingigatas)
3 Feeds self using spoon with spillage. Names objects in pictures
4
4 Feeds self using fingers without spillage. 5 Speaks in grammatically correct 2-3 word sentences
5 Feeds self using spoon without spillage. 6 Asks “what” questions
6 Eats without need for spoon feeding during any meal. 7 Asks “who”' and “why” questions
8 Gives account of recent experiences (with prompting)
7 Helps hold cup for drinking. in order of occurrence using past tense
8 Drinks from cup with spillage. Total Score
9 Drinks from cup unassisted.
10 Gets drink for self unassisted.
COGNITIVE DOMAIN BoSY EoSY
11 Pours from pitcher without spillage.
P O R P O R