10/2/12 Checklist Form 2 Eng Print Ready

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PhilippineEarlyChildhood
DevelopmentChecklist
Form2
(3.05.11yearsold)
Childs Name: ______________________________________________
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10/2/12 Checklist Form 2 Eng Print Ready
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Birthdate: ___________ Age:________asof_________

ChildsName:______________________________________________________
Province:____________Municipality/City:___________Barangay:___________
Sex: _______Male Handedness: __________Right
_______Female __________Left
TotheParents:
ThePhilippineEarlyChildhoodDevelopmentChecklist(Form2)containsknowledge,
skillsandattitudesofchildren35.11yearsold.Thismaybeusedasaguidein
knowing your child and consequently give appropriate care and teaching to guide
theirgrowthanddevelopment.
Content:
Everypagecontainsdifferentdomainsofdevelopmentwiththeircorrespondingtotal
scores:
-GrossMotorDomainhas13items -ExpressiveLanguageDomainhas8
items
-Fi neMotorDomai nhas11i tems -Cogni ti veDomainhas21i tems
-Self -hel pDomai nhas27items -Social -Emot ional Domai nhas24items
-ReceptiveLanguageDomainhas5
items
Eachitemobservedarerecordedthreetimewithinayear:1)atthestartofthe
year,2)atthemiddleoftheyear,and3)attheendoftheyear.
Columns:
PPresentorthechildcandothetask
OObservedorthechildwasobserveddoingthetask
RReportgivenbytheparents/caregiverabouttheskill
Score:




15. Helpswithfamily
chores(e.g.,wiping
tables, watering
plants,etc.)
16. Curiousabout
environmentbut
knowswhentostop
askingquestionsof
adults
17. Wai tsfort urn
18. Askspermissionto
playwithtoybeing
usedbyanother
19. Defendspossessions
with determination
20. Playsorganized
groupgamesfairly(e.
g.,doesnotcheatin
ordertowin)
21. Cantalkaboutdifficult
feelings(e.g.,anger,
sadness,worry)he
experiences.
22. Honorsasimple
bargainwithcaregiver
(e.g.,canplayoutside
onlyafter
cleaning/finishing his
room)
23. Watchesresponsibly
overyounger
siblings/family
members
24. Cooperateswith
adultsandpeersin
groupsituationsto
minimizequarrelsand
conflicts
TOTALSCORE:

( )Presentorchildisabletodothetask
(-)Skillisnotpresentorchilddoesnotrespond
(-9)noopportunitytoobservetheskill


culturalgesturesof
greetingswithoutmuch
prompting(e.g.,mano,
bless,kiss,etc.)
13. Comforts
playmates/siblingsin
distress
14. Persistswhenfacedwith
aproblemorobstacleto
hiswants





1. enj oyswatchi ngact ivit ies
ofnearbypeopleor
animals

1. Cli mbsonchair or
otherelevatedpiece
offurniturelikea
bedwithouthelp
2.
10/2/12 Checklist Form 2 Eng Print Ready
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8. Demonst ratesrespect for
eldersusingtermslike
poandopo
9. Sharest oyswit hother s
10. Imitatesadultactivities
(e.g.,cooking,washing)
11. Identifiesfeeli ngsi n
others
12. Appropriatelyuses


2. Fri endl ywit hstr angers
butinitiallymayshow
slightanxietyorshyness
3. Playsal onebut li kest obe
nearfamiliaradultsor
brothersandsisters



4. Laughsor squealsal oud
inplay
5. Playspeek- a-boo
(bulaga)
6. Rol lsball interact ivel y
withcaregiver/examiner
7. Hugsor cuddlest oys
2.
Walksbackwards

3. Runs without
trippingorfalling
4. Walksdownst ai rs,
2feetoneach
step,withone
handheld
5. Walks upstairs
holdinghandrail,2
feetoneachstep
6. Walks upstairs
withalternatefeet
withoutholding
handrail
7. Walksdownst airs
withalternatefeet
withoutholding
handrail
8. Moves body part
asdirected
9. Jumps up
10. Throwsball
overheadwith
direction
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Preschool Activities
Interactive Books For Your Kids Apply For Free Presentation
www.ETLlearning.com
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