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Department of Education

Region: ______________________________________ District: __________________________________________


Division: _____________________________________ Barangay: ________________________________________
City/Municipality: _______________________________ School: ___________________________________________

SUMMARY REPORT ON EARLY CHILDHOOD DEVELOPMENT CHECKLIST ECCD FOR KINDERGARTEN


No. of Items which the child failed to exhibit/perform per domain Remarks

Sum of Scaled
Social

Standard
Self-help Receptive Expressive Cognitive

Not Ready
Score

Score
Name of Pupils Age Sex Gross Motor Fine Motor Emotional

Ready
Domain Domain Domain Domain
Domain
Raw Scaled Raw Scaled Raw Scaled Raw Scaled Raw Scaled Raw Scaled Raw Scaled
Score Score Score Score Score Score Score Score Score Score Score Score Score Score

Submitted by: NOTED:


_____________________________________ _____________________________________
Name of Teacher School Head

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