Physical Development Checklist

Name of Child: _________________________________ Age: _______________

Observer: _______________________ Date: __________________

Aim of the observation: _________________________________________________

_________________________________________________

Objective of the observation: _____________________________________________

_____________________________________________

No Item Remarks Date

1. Able to walks and runs on both feet.
2. Can climbs on furniture and can get
down.
3. Able to climb stairs holding on with two
feet on each stair.
4. Can builds tower of 6 blocks.
5. Able to hold crayon with whole hand.
6. Imitates an adult making circular
strokes or dots on a piece of paper using
crayon.
7. Can use spoon well.
8. Needs help in dressing
9. Can jump in place with both feet
10. Able to kick a stationary ball.
11. Can ride tricycle.
12. Imitates an adult making cross on a
piece of paper using crayon.
13. Uses spoon and fork properly without
dirty the table.

Comments: ___________________________________________________________
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___________________________________________________________

Conclusion: ___________________________________________________________
___________________________________________________________
___________________________________________________________

Evaluation: ___________________________________________________________
___________________________________________________________
___________________________________________________________

Follow-up: ___________________________________________________________
___________________________________________________________
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