SOCIO- EMOTIONAL BoSY EoSY

Child’s Name: ______________________________ Region III-Central Luzon

Sex:_________ Date of Birth:__________________ Schools Division of Tarlac Province
DOMAIN
Address: __________________________________
P O R P O R Victoria West District
1
Enjoys watching activities of people or nearby Child’s Handedness: (Check Appropriate Box) SAN FRANCISCO ELEMENTARY SCHOOL
animals.
Right Left Not yet established (106795)
Friendly w/ strangers but may initially show slight
2
shyness. S.Y. 2018-2019
Father’s Name: ______________________________
Plays alone but likes to be near to familiar adults or
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:_________________________________ Early Childhood Care and
Educational Attainment: _______________________ Development (ECCD)
7 Hugs or cuddles toys.
Demonstrates respect for elders using “po” and SUMMARY OF ASSESMENT
8
“opo”.

9
Shares toys with others familiar adults or brother and Checklist
sister.
BoSY EoSY
10 Imitates adults activities (e.g. cooking, washing) Date Assessed
Pupil’s Age
11 Identifies feelings of others. Domains RS SC RS SC

Appropriately uses cultural gestures of greetings Gross-Motor

12
without much prompting( e.g. mano/bless, kiss, etc.) Fine Motor
13 Comforts playmates/siblings in distress. Self-Help
Receptive Language
Persists when faced with a problem or obstacle to his
14 Expressive Language
wants. Name: __________________________
Cognitive
Helps with family chores(e.g. wiping tables, watering Sex: __________________
15
plants) Socio-emotional
Curious about environment but knows when to stop Sum of Scaled Scores Birthday: __________________
16
asking questions to adult.
RS – Raw Score
Standard Scores LRN: -
17 Waits for turns. SC – Scaled Score
Asks permission to play with toys being used by
18
others. INTERPRETATION To the Parents:
The Philippine Early Childhood Care and Development Checklist
19 Defends possessions with determination.
BoSY: (Form 2) contains knowledge, skills, and attitudes of children 3 – 5.11 years
Plays organized group games fairly(e.g. does not
old. This may be used as a guide in knowing your child and consequently give
20 appropriate care and teaching to guide their growth and development.
cheat in order to win).

21
Can talk about difficult feelings (e.g. anger, sadness, PARENT’S SIGNATURE
worry) he experience.

22
Honors a simple bargain with caregiver (e.g., can EoSY:
play outside only after cleaning/fixing his room)
MAY G. ULOG
Watches responsibly over younger siblings/family
23 Teacher
members.
Cooperates with adults and peers in group situations
MA. ROSARIO G. ASTRERO
24
to minimize quarrels and conflicts. PARENT’S SIGNATURE Principal I

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
PUPIL’S SOCIO-DEMOGRAPHIC PROFILE bed without help
2 Walks backward. 11 Pours from pitcher without spillage. P O R P O R
1 Looks at direction of fallen object
3 Runs without tripping or falling. 12 Prepares own food/snacks.
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
color)
1 (e.g. comfort room)
Goes to the designated place to urinate (pee) or move
12 Arranges objects according to size from smallest to
1 Jumps and turns.
biggest
21 bowels (poop) but sometimes still does this in his
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 15 Names 3 animals or vegetables when asked
Total Score anymore
Wipes/Cleans self after a bowel movement (poop) 16 States what common household items are used for
23
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., Ang aso ay malaki, ang
P O R P O R
Washes face without any help. daga ay _____”)
Uses all five fingers to get food/toys placed on flat surface. 26
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. Ano
3 Displays a definite hand preference. Total Score ang mali sa larawang ito?)
2 Matches upper and lower case letters
Puts small objects in/out of containers.
4 1
5
Holds crayon with all fingers of his hand making a fist (i.e. 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. 1 Points to family member when asked to do so P- Present
8 Scribbles vertical and horizontal lines.
2 Points to 5 body parts on himself when asked to do so O-Observed
9 Draws circle purposely. 3 Points to 5 named pictured objects when asked to do so
Draws a human figure (head, eyes, trunk, arms,
R- Reported by parent/guardian
10 4 Follows one-step instructions that include simple
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. hingi
gatas)
3 Feeds self using spoon with spillage. 4 Names objects in pictures
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