GROSS MOTOR DOMAIN 1 2 FINE MOTOR DOMAIN 1 2 1 2 SELF- HELP DOMAIN 1 2
SELF- HELP DOMAIN
REPUBLIC OF THE PHILIPPINES 1 Climbs on chair or 1 To get food/toys. 1 Feeds self with 14 Participates when being Department of Education other elevated piece finger foods (e.g. dressed (e.g. raises Region X-Northern Mindanao of furniture like a bed 2 Picks up objects biscuits, bread) arms.lefts leg) Division of Lanao del Norte without help. with thumb and using fingers. index finger. 15 Pulls down gartered 2 Walks backward. 2 Feeds self, using 3 Displays a definite short pants CAMP 3 ELEMENTARY SCHOOL spoon without 3 Runs without tripping hand preference. 16 Removes sando School Year: 2017-2018 spillage. or falling 4 Puts small objects 3 Feeds self, using 17 Dresses without spoon wit spillage. PHILIPPINE EARLY CHILDHOOD 4 Walks down stairs, 2 in/out of assistance except for DEVELOPMENT CHECKLIST feet on each step, with containers buttons and tying 4 Feeds self, using one hand held 5 Holds crayon with 18 Dresses without (FORM 2) all five fingers (i.e . fingers without spillage. assistance including palmar grasp) butons and tying 5 Walks upstairs holding 5 Feeds self, using Name: _______________________ 19 Informs tha adult only handrail, 2 feet on fingers without each feet 6 Lid of container or spillage. after he has already LRN #: ________________________ unwraps food urinated or moved his 6 Eats without need for spoon feeding bowels in his underpants SEX: _____________ 6 Walks upstairs with 20 Informs adult of need to alternate feet without during any meal urinate or move bowels Date of Birth: __________________ holding handrail 7 Scribbles so he can be brought to spontaneously. 7 Helps hold cup for drinking. a designated place (e.g Preferred Hand:______Right _____left 7 Walks downstairs with CR) alternate feet without 8 Drinks from cup 21 Goes to the designated holding the handrail 8 Scribbles vertical with spillage. place to urinate or move Date of Child’s and horizontal Examination bowels but sometimes Examination Age lines 9 Drinks from cup still does this in his 8 Moves body part as First Exam 9 Draws circle unassisted. underpants. directed Second purposely. 22 Goes to the designated 10 Draws a human 10 Gets drink for self place to urinate or move Exam 9 Jumpsup. figure ( head, eyes, unassisted. bowels and never does trunk, arms, this in his underpants Prepared by: 10 Throws ball overhead hands/finger) 11 Pours from pitcher 23 Wipes/clean self after a with direction without spillage. bowel movement. NENA LYN A. MAGHANOY 11 Hops 1 to 3 steps on 24 Participates when 11 Draws a house 12 Prepares own bathing (e.g.rubbing Kindergarten Teacher preferred foot using geometric food/snacks. arms with soap). forms. 12 Jumps and turns. 25 Washes and dries hand Noted: 13 Prepares meals for without any help. younger Washes
DIOSCORA P. CAGOD 13 Dances patterns/joins 26 Washes face without any
group movement siblings/family help School Head activities. members when no adult is around. 27 Bathes without any help.
TOTAL SCORE: TOTAL SCORE: TOTAL SCORE:
COGNITIVE DOMAIN 1 2 SOCIO – EMOTIONAL 1 2 17 Curious about RECEPTIVE LANGUAGE 1 2 1 Looks at direction of DOMAIN environment but knows INTERPRETATION: DOMAIN fallen objects. 1 Enjoys watching when to stop asking 1 Points to a family member 2 Looks for hidden activities of nearby questions of adults. people or animals. 18 Waits for turn. 1ST Examination: when asked to do so. objects. 3 Imitates behavior just 2 Friendly with strangers 19 Defend possessions with __________________________ 2 Points to 5 body parts on seen a few minutes but initially may show determination. __________________________ himself when asked to do slight anxiety or shyness. 20 earlier. Plays organized group __________________________ so. 3 Plays alone but likes to games fairly. (e.g. does 4 Offers objects but will ND 2 Examination: 3 Points to 5 named picture be near familiar adults or not release it. not cheat in order to brothers and sisters. __________________________ objects when asked to do 5 Looks for completely win) 4 Laughs or squeals so. hidden objects 21 Can talk about difficult __________________________ aloud in play. 4 Follows one- step 6 Exhibits simple 5 Plays peek-a-boo feelings (e.g. anger, __________________________ instruction that include pretend play sadness, worry)he (bulaga) simple prepositions 7 Matches objects. 6 Rolls ball interactively experiences. LEGEND 8 22 Honors a simple bargain STANDARD INTERPRETATION (e.g.in,on,under) Matches 2-3 colors. with caregiver. with caregiver (e.g. can 5 Follows 2-step instructions 9 Matches pictures. examiner. SCORE 10 7 play outside only after that include simple Sorts based on shapes. Hugs or cuddles toys. 69 and Suggest significant delay in cleaning/finishing this prepositions. 11 Sorts objects based on 8 Demonstrates respect for elders using terms like room. below overall development. 2 attributes. 23 TOTAL SCORE: 12 Arranges objects “po” and “opo”. Watches responsibility 70-79 Suggest slight delay in according to size from 9 Shares toys with over younger overall development. smallest to the biggest. others siblings/family members. EXPRESSIVE LANGUAGE 1 2 24 Cooperates with adults 80-119 Average development 13 Names 4-6 colors. 10 Imitates adult DOMAIN activities (e.g cooking, and peers in group 120-129 Suggest slightly advanced Uses 5-20 recognizable 14 Copies shapes. situations to minimize development. 1 washing) words. 15 Names 3 animals or 11 Identifies feelings in quarrels and conflicts. 130 and Suggest highly advanced 2 Uses pronouns vegetables when others. TOTAL SCORE: above development. asked. 12 Appropriately uses 3 Uses 2-3 verb- noun 16 States what common cultural gestures of combinations (hinngi greeting without much RAW SCORE SCALED SCORE household items are gatas) used prompting. DOMAIN 1st 2nd 1st 2nd 4 Names objects in pictures. 17 Can assemble simple 13 Comforts Speaks grammatically playmates/siblings in GROSS 5 puzzles Demonstrates an distress. FINE correct 2-3 word 18 understanding of 14 Persist when faced sentences. with a problem or SELF – HELP opposites by completing 6 Ask “what” questions. a statement. obstacles to his wants. RECEPTIVE 7 Asks “who” and “why” 19 Points to left and right 15 Helps with family chores EXPRESSIVE questions. sides of body (e.g. wiping tables, watering plants etc.) COGNITIVE 8 Gives account of recent 20 Can state what is silly or wrong with 16 Asks permission to SOCIO – experiences (with prompting in order of concurrence using pictures. play with toy being EMOTIONAL 21 Matches upper and used by another. past tense. SUM OF SCALED lower case letters. SCORE TOTAL SCORE: TOTAL SCORE: STANDARD SCORE