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    Checklist Form 2 Eng Print Ready

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    Rogen Hemodo
    The document is a checklist used to assess development in Filipino children ages 3 to 5 years old. It contains items to evaluate seven domains of development: gross motor, fine motor, self-help, receptive language, expressive language, cognitive, and social-emotional. For each domain, there are age-specific items to observe if a child can perform a task or skill. Scores are recorded three times per year to track progress. The checklist is intended to help caregivers understand a child's development and provide appropriate guidance.

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    Checklist Form 2 Eng Print Ready

    Uploaded by

    Rogen Hemodo
    34K views7 pages
    The document is a checklist used to assess development in Filipino children ages 3 to 5 years old. It contains items to evaluate seven domains of development: gross motor, fine motor, self-help, receptive language, expressive language, cognitive, and social-emotional. For each domain, there are age-specific items to observe if a child can perform a task or skill. Scores are recorded three times per year to track progress. The checklist is intended to help caregivers understand a child's development and provide appropriate guidance.

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    The document is a checklist used to assess development in Filipino children ages 3 to 5 years old. It contains items to evaluate seven domains of development: gross motor, fine motor, self-help, receptive language, expressive language, cognitive, and social-emotional. For each domain, there are age-specific items to observe if a child can perform a task or skill. Scores are recorded three times per year to track progress. The checklist is intended to help caregivers understand a child's development and provide appropriate guidance.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as DOC, PDF, TXT or read online from Scribd
    Download as doc, pdf, or txt
    34K views7 pages

    Checklist Form 2 Eng Print Ready

    Uploaded by

    Rogen Hemodo
    The document is a checklist used to assess development in Filipino children ages 3 to 5 years old. It contains items to evaluate seven domains of development: gross motor, fine motor, self-help, receptive language, expressive language, cognitive, and social-emotional. For each domain, there are age-specific items to observe if a child can perform a task or skill. Scores are recorded three times per year to track progress. The checklist is intended to help caregivers understand a child's development and provide appropriate guidance.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as DOC, PDF, TXT or read online from Scribd
    Download as doc, pdf, or txt
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    The document describes a checklist used to track the development of children ages 3 to 5.11 years old across several domains.

    The Philippine Early Childhood Development Checklist is used as a guide for parents and caregivers to understand their child's development and provide appropriate care and teaching to support their growth.

    The checklist assesses development in gross motor skills, expressive language, fine motor skills, cognitive abilities, self-help skills, social-emotional skills, and receptive language.

    Philippine Early Childhood Development Checklist

    Form 2 (3.0 5.11 years old)

    Childs Name: ______________________________________________ Birthdate: ___________ Age: ________ as of _________ Sex: _____

    Childs Name: ______________________________________________________ Province: ____________Municipality/City: ___________ Barangay:___________ Sex: _______ Male _______ Female Handedness: __________ Right __________ Left

    15.

    16.

    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 13 items - Fine Motor Domain has 11 items - Self-help Domain has 27 items - Receptive Language Domain has 5 items - Expressive Language Domain has 8 items - Cognitive Domain has 21 items - Social-Emotional Domain has 24 items

    17. 18. 19. 20.

    21.

    22.

    Each item observed are recorded three time 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 task O Observed or the child was observed doing the task R Report given by the parents/caregiver about the skill

    23.

    24.

    SOCIAL EMOTIONAL DOMAIN Helps with family chores (e.g., wiping tables, watering plants, etc.) Curious about environment but knows when to stop asking questions of adults Waits for turn Asks permission to play with toy being used by another Defends possessions with determination Plays organized group games fairly (e. g., does not cheat in order to win) Can talk about difficult feelings (e.g., anger, sadness, worry) he experiences. Honors a simple bargain with caregiver (e.g., can play outside only after cleaning/finishing his room) Watches responsibly over younger siblings/family members Cooperates with adults and peers in group situations to minimize quarrels and conflicts TOTAL SCORE:

    O R COMMENTS

    O R COMMENTS

    O R COMMENTS

    Score:

    ( ) Present or child is able to do the task ( - ) Skill is not present or child does not respond ( -9) no opportunity to observe the skill
    13. 14.

    cultural gestures of greetings without much prompting (e.g., mano, bless, kiss, etc.) Comforts playmates/siblings in distress Persists when faced with a problem or obstacle to his wants GROSS MOTOR DOMAIN 3.1 4.0 Years Gross Motor Climbs on chair or other elevated piece of furniture like a bed without help Walks backwards 4.1 5.0 Gross Motor Runs without tripping or falling Walks down stairs, 2 feet on each step, with one hand held Walks upstairs holding handrail, 2 feet on each step Walks upstairs with alternate feet without holding handrail Walks downstairs with alternate feet without holding handrail Moves body part as directed Jumps up Throws ball overhead with direction .1 5.11 P O R COMMENTS P O R COMMENTS P O R COMMENTS P O R COMMENTS P O R COMMENTS P O R COMMENTS

    A. 3.1 5.0 Years


    1. 2. SOCIAL - EMOTIONAL DOMAIN enjoys watching activities of nearby people or animals Friendly with strangers but initially may show slight anxiety or shyness Plays alone but likes to be near familiar adults or brothers and sisters SOCIAL - EMOTIONAL DOMAIN Laughs or squeals aloud in play Plays peek-a-boo (bulaga) Rolls ball interactively with caregiver/examiner Hugs or cuddles toys B. 5.1 5.11 Years SOCIAL - EMOTIONAL DOMAIN Demonstrates respect for elders using terms like po and opo Shares toys with others Imitates adult activities (e.g., cooking, washing) Identifies feelings in others Appropriately uses
    P O R

    SOCIAL-EMOTIONAL DOMAIN
    COMMENTS P O R COMMENTS P O R COMMENTS

    A.
    1.

    2. B. 3.
    P O R COMMENTS P O R COMMENTS P O R COMMENTS

    3.

    4.

    4. 5. 6. 7.

    5. 6.

    P O R COMMENTS

    O R COMMENTS

    O R COMMENTS

    7.

    8. 9. 10. 11. 12.

    8. 9. 10. C.

    FINE MOTOR DOMAIN

    A. 3.1 4.0 Years Fine Motor


    1. 2. 3. 4. 5. Uses all 5 fingers to get food/toys placed on flat surface Picks up objects with thumbs and index finger Displays a definite hand preference Puts small objects in/out of containers Holds crayon with all fingers of his hand making a fist (I.e., palmar grasp)

    10.
    P O R COMMENTS P O R COMMENTS P O R COMME NTS

    11. 12. 13.

    Gross Motor Throws ball overhead with direction Hops 1 to 3 steps on preferred foot Jumps and turns Dances patterns/joins group movement activities TOTAL SCORE:

    P O R COMMENTS

    P O R COMMENTS

    P O R COMMENTS

    A. 3.1 4.0 Years COGNITIVE DOMAIN 6. P O R COMMENT S P O R COMMENTS P O R COMM ENTS Exhibits simple pretend play(feed, put doll to sleep) Matches objects

    P O R COMMENTS

    P O R COMMENTS

    P O R COMMENTS

    B. 4.1 5.0 Year Fine Motor


    6. 7. 8. Unscrews lid of container or unwraps food Scribbles spontaneously Scribbles vertical and horizontal lines C. 5.1 5.11 Fine Motor 9. 10. 11. Draws circle purposely Draws a human figure (head, eyes, trunk, arms, hands/fingers) Draws a house using geometric forms TOTAL SCORE:

    7.

    B. 4.1 5.0 Years


    8. 9. 10. 11. P O R COMMENTS P O R COMMENTS P O R COMM ENTS 12. 13. 14. 15. 16. COGNITIVE DOMAIN Matches 2-3 colors Matches pictures Sorts based on shapes Sorts objects based on 2 attributes (e.g., size and color) Arranges objects according to size from smallest to biggest Names 4-6 colors Copies shapes Names 3 animals or vegetables when asked States what common household items are used for P O R COMMENTS P O R COMMENTS P O R COMMENTS

    C. 5.1 5.11 Years


    17. COGNITIVE DOMAIN Cam assemble simple puzzles P O R COMMENTS P O R COMMENTS P O R COMMENTS

    18.

    19. 20.

    21

    Demonstrates an understanding of opposites by completing a statement (e.g., Ang aso ay malaki, ang daga _____) Points to left and right sides of body Can state what is silly or wrong with pictures (e.g. Ano ang mali sa larawang ito? Matches upper and lower case letters TOTAL SCORE:

    D.

    3.1 4.0 Years


    P O R COMMENTS P O R COMMENTS P O R COMMENTS

    1. 2. 3. 4. 5.

    COGNITIVE DOMAIN Looks at direction of fallen object Looks for partially object hidden Imitates behavior just seen a few minutes earlier Offers object but will not release it Looks for completely hidden object

    EXPRESSIVE LANGUAGE DOMAIN

    A. 3.1 4.0 Years


    1. SELF-HELP Feeds self with finger food (e.g. biscuits, bread) using fingers Feeds self using fingers with spillage Feeds self using spoon with spillage Feeds self using fingers without spillage Feeds self using spoon without spillage B. 4.1 5.0 Years SELF-HELP Eats without need for spoon feeding during any meal Helps hold cup for drinking Drinks from cup with spillage C. 5.1 5.11Years SELF-HELP Drinks from cup unassisted

    SELF-HELP DOMAIN P O R COMMENTS P O R COMMENTS P O R COMMENTS

    A. 3.1 5.0 Years


    1. 2. 3. 4. EXPRESSIVE LANGUAGE DOMAIN Uses 5-20 recognizable words Uses pronouns (e.g. I, me, ako, akin) Uses 2-3 words verbnoun combinations (e.g. hingi gatas) Names objects in pictures
    P O R COMMENTS P O R COMMENTS P O R COMMENTS

    2. 3. 4. 5.

    B. 5.1 5.11 Years


    EXPRESSIVE LANGUAGE DOMAIN Speaks in grammatically correct 2-3 word sentences Asks whatquestions Asks who and why questions Gives account of recent experiences (with prompting) in order of occurrence using past tense TOTAL SCORE:
    P O R COMMENTS P O R COMMENTS P O R COMMENTS

    P O R COMMENTS

    P O R COMMENTS

    P O R COMMENTS

    5. 6. 7. 8.

    6. 7. 8.

    P O R COMMENTS

    P O R COMMENTS

    P O R COMMENTS

    9. COGNITIVE DOMAIN

    10. 11. 12. 13.

    Gets drink for self unassisted Pours from pitcher without spillage Prepares own food/snack Prepares meals for younger siblings/family members when no adult is around
    22.
    P O R COMMENTS P O R COMMENTS P O R COMMENTS

    designated place to urinate (pee) or move bowels (pooh) and never does this is his underpants anymore

    SELF-HELP Dressing Sub-Domain 14. Participates when being dressed (e.g. raises arms or lifts leg) 15. Pulls down gartered short pants Removes sando Dresses without assistance except for buttons and tying Dresses without assistance including buttons and tying

    SELF-HELP Goes to the designated place to urinate (pee) or move bowels (pooh) and never does this is his underpants anymore Wipes/Cleans self after a bowel movement (pooh) Participates when bathing (e.g. rubbing arms with soap) Washes and dries hands without any help Washes face without any help Bathes without any help TOTAL SCORE:

    P O R COMMENTS

    P O R COMMENTS

    P O R COMMENTS

    23. 24. 25. 26. 27.

    16. 17. 18.

    Toilet Training sub-domain 19. Informs the adult only after he has already urinated (peed) or moved his bowels (poohed) in his underpants 20. Informs adult of need to urinate (pee) or move bowels (poohpooh) so he can be brought to a designated place (e.g. comfort room) Goes to the

    A. 3.1 5.11 Years


    RECEPTIVE LANGUAGE DOMAIN Points to family member when asked to do so Points to 5 body parts on himself when asked to do so Points to 5 named pictured objects when asked to do so

    RECEPTIVE LANGUAGE DOMAIN P O R COMMENTS P O R COMMENTS P O R COMMENTS

    1. 2.

    3.

    21.

    4.

    5.

    Follows one-step instructions that include simple prepositions Follows 2-step instructions that include simple prepositions TOTAL SCORE:

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