POS PANGASINAN DIVISION II

SOCIO-EMOTIONAL DOMAIN PRE

T
STANDARD SCORE INTERPRETATION SISON DISTRICT
1 Enjoys watching activities of people or nearby animals. ASAN SUR ELEMENTARY SCHOOL
69 & Below Suggest significant delay in overall Asan Sur, Sison, Pangasinan
2 Friendly w/ strangers but may initially show slight shyness.
development
3
Plays alone but likes to be near to familiar adults or brother 70-79 Suggest slight delay in overall development
and sister.
80-119 Average Development
4 Laughs or squeals aloud in play.
120-129 Suggest Advanced Development
5 Plays peek-a-boo (bulaga).
130 ABOVE Suggest Highly Advanced Development
6 Rolls ball interactively with caregiver/ examiner.
7 Hugs or cuddles toys. SUMMARY OF
8 Demonstrates respect for elders using “po” and “opo”. ASSESMENT Early Childhood Development
PRE EVALUATION (ECD) CHECKLIST)
9 Shares toys with others familiar adults or brother and sister.

INTERPRETATION LRN: 1 0 2 0 1 8 2 4 0 0 2 3
10 Imitates adults activities (e.g. cooking, washing)
PARENT’S 1
SIGNATURE PUPIL’S SOCIO-DEMOGRAPHIC PROFILE
11 Identifies feelings of others.
Child’s Name:
Appropriately uses cultural gestures of greetings without PRE- POST
12
much prompting( e.g. mano/bless, kiss, etc.) EVALUATION EVALUATION __________________________________
Date Assessed Sex: ___ Date of Birth: __________
13 Comforts playmates/siblings in distress.
Pupil’s Age
Address: ASAN SUR, SISON,
Raw Scaled Raw Scaled
PANGASINAN
14 Persists when faced with a problem or obstacle to his wants. Domains
Score Score Score Score
Gross-Motor Child’s Handedness: (Check Appropriate Box)
15 Helps with family chores(e.g. wiping tables, watering plants) Right Left Not yet established
Fine Motor √
Curious about environment but knows when to stop asking
16 Self-Help
questions to adult. Father’s Name:
Receptive Language _______________________________
17 Waits for turns.
Expressive Language Occupation:
PRE EVALUATION __________________________________
Cognitive
18 Asks permission to play with toys being used by others.
Socio-emotional
Educational Attainment:
19 Defends possessions with determination.
_________________________
Sum of Scaled Scores Mother’s Name:
20
Plays organized group games fairly(e.g. does not cheat in Standard Scores ________________________________
order to win).
Occupation:
21
Can talk about difficult feelings (e.g. anger, sadness, worry) __________________________________
he experience. POST EVALUATION
Educational Attainment:
Honors a simple bargain with caregiver (e.g., can play _________________________
22 INTERPRETATION
outside only after cleaning/fixing his room)
PARENT’S
23 Watches responsibly over younger siblings/family members. SIGNATURE To the Parents:
The Philippine Early Childhood Care and Development
24
Cooperates with adults and peers in group situations to
minimize quarrels and conflicts.
Republic of the Philippines 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
Department of Education and consequently give appropriate care and teaching to guide their
Total Score Region I growth and development.

1-3 Suggest significant delay in overall development

4-6 Suggest slight delay in overall development
SCALED SCORE INTERPRETATION 7-13 Average Development
14-16 Suggest Advanced Development
17-19 Suggest Highly Advanced Development
 MARISSA L. 7 Helps hold cup for drinking. 8 Gives account of recent experiences (with prompting) in
order of occurrence using past tense
TAMONDONG 8 Drinks from cup with spillage.
Total Score
Teacher III/Adviser 9 Drinks from cup unassisted.
ROSA FLOR S. MANGAY-AT, EdD 10 Gets drink for self unassisted.
Principal III 11 Pours from pitcher without spillage. COGNITIVE DOMAIN PRE POST
12 Prepares own food/snacks. 1 Looks at direction of fallen object
GROSS MOTOR DOMAIN 13 Prepares meals for younger siblings/ family members 2 Looks for partially hidden object
PRE POS when no adult is around.
Participates when being dressed. 3 Imitates behavior just seen a few minutes earlier
T 14
1 Climbs on chair or elevated piece of furniture like a bed 15 Pulls down gartered short pants. 4 Offers object but will not release it
without help
16 Removes sando. 5 Looks for completely hidden object
2 Walks backward.
3 Runs without tripping or falling. Dresses without assistance except buttons and tying.
17 6 Exhibits simple pretend play (feed, put doll to sleep)
4 Walks down stairs, 2 feet on each step, with one hand
held. Dresses without assistance including buttons and tying.
18 7 Matches objects
5 Walks upstairs holding handrail, 2 feet on each step.
6 Walks upstairs with alternate feet without holding Informs the adult only after he has already urinated 8 Matches 2 – 3 colors
19 (peed) or moved his bowels (pooped) in his underpants.
handrail.
Informs adult of need to urinate (pee) or move bowels 9 Matches pictures
7 Walks downstairs with alternate feet without holding
handrail. 20 (poop) so he can be brought to a designated place (e.g. 10 Sorts objects based on 2 attributes (e.g., size and color)
8 Moves body part as directed. comfort room)
9 Jumps up Goes to the designated place to urinate (pee) or move
21 bowels (poop) but sometimes still does this in his 11 Sorts objects based on 2 attributes (e.g.,shape and
10 Throws ball overhead with direction. color)
underpants.
11 Hops 1 to 3 steps on preferred foot.
12 Jumps and turns. Goes to the designated place to urinate (pee) or move 12 Arranges objects according to size from smallest to
22 bowels (poop) and never does this in his underpants biggest
13 Dances patterns/joins group movement activities. anymore
Total Score 13 Names 4 – 6 colors
23 Wipes/Cleans self after a bowel movement (poop)
Participates when bathing (e.g. rubbing arms with soap) 14 Copies shapes
24
FINE MOTOR DOMAIN PRE POST 15 Names 3 animals or vegetables when asked
25 Washes and dries hands without any help.
Uses all five fingers to get food/toys placed on flat 16 States what common household items are used for
1 26 Washes face without any help.
surface.
2 Picks up objects with thumb and index finger. 27 Bathes without any help. 17 Can assemble simple puzzles
3 Displays a definite hand preference. Demonstrates an understanding of opposites by
Total Score 18
4 Puts small objects in/out of containers. completing a statement (e.g., Ang aso ay malaki, ang
daga ay _____”)
Holds crayon with all fingers of his hand making a fist
5
(i.e. palmar grasp) RECEPTIVE LANGUAGE PRE POS 19 Points to left and right sides of body
6 Unscrews lid of container or unwraps food. T
1 Points to family member when asked to do so 20 Can state what is silly or wrong with pictures (e.g. Ano
7 Scribbles spontaneously.
2 Points to 5 body parts on himself when asked to do so ang mali sa larawang ito?)
8 Scribbles vertical and horizontal lines.
21 Matches upper and lower case letters
9 Draws circle purposely.
3 Points to 5 named pictured objects when asked to do
Draws a human figure (head, eyes, trunk, arms, so Total Score
10
hands/fingers)
4 Follows one-step instructions that include simple
11 Draws a house using geometric forms. prepositions (e.g., in, on, under, etc.) COMPUTATION OF CHILD’S AGE
Total Score 5 Follows 2-step instructions that include simple EXAMINER’S
prepositions YEAR MONTH DAY
NAME
Total Score
Date Tested
SELF HELP DOMAIN PRE Child’s date MARISSA L.
PRE POS
T EVALUATION of Birth TAMONDONG
1 Feeds self with finger foods (e.g. biscuits, bread) EXPRESSIVE LANGUAGE PRE POST Child’s Age
using fingers. 1 Uses 5-20 recognizable words POST Date Tested
2 Feeds self using fingers with spillage. 2 Uses pronouns (e.g. I, me, ako, akin) EVALUATION Child’s date MARISSA L.
3 Feeds self using spoon with spillage. 3 Uses 2-3 words verb-noun combinations (e.g. hingi gatas) of Birth TAMONDONG

4 Feeds self using fingers without spillage.

Child’s Age
4 Names objects in pictures
5 Feeds self using spoon without spillage. 5 Speaks in grammatically correct 2-3 word sentences
6 Eats without need for spoon feeding during any meal. 6 Asks “what” questions
7 Asks “who”' and “why” questions