Republic of the Philippines TEACHER’S NOTES, DESCRIPTIONS, GROSS MOTOR DOMAIN

Assessment
SELF HELP DOMAIN
Assessment
1st 2nd 3rd 1st 2nd 3rd
DEPARTMENT OF EDUCATION AND OBSERVATIONS Climbs on chair or other elevated piece Feeds self with finger food (e.g. biscuits,
1 1
Region IV-A of furniture like a bed without help bread) using fingers
Division of Rizal First Assessment: 2 Walks backward 2 Feeds self using fingers with spillage
Eulogio Rodriguez Jr., Elementary School 3 Runs without tripping or failing 3 Feeds self using spoon with spillage
Second Assessment: 4
Walks downstairs, 2 feet on each step 4 Feeds self using fingers without spillage
Early Childhood Care and with one hand held
5 Feeds self using spoon without spillage
Walks upstairs holding handrail, 2 feet
Development (ECCD) Checklist Third Assessment: 5
on each step 6
Eats without need for spoon feeding
Walks upstairs with alternate feet during any meal
6
Child’s Name: without holding handrail 7 Helps hold cup for drinking
Level & Section: Walks downstairs with alternate feet 8 Drinks from cup with spillage
PARENT’S SIGNATURE 7
without holding handrail
Date of Birth: Age: 9 Drinks from cup unassisted
8 Moves body part as directed
Sex: School Year: Gets drink for self unassisted
Address: First Assessment: 9 Jumps up
10

Second Assessment: 11 Pours from pitcher without spillage

School Readiness Year-End Assessment (SReYA) Score 10 Throws ball overhead with direction
Third Assessment: 12 Prepares own food / snack
Handedness: Right Left 11 Hops 1 to 3 steps on preferred foot
Prepares meals for younger
Both Not yet established 12 Jumps and turns
ATTENDANCE RECORD 13 siblings/family members when no adult
Birth Order: 1st Child 2nd Dances patterns/joins group movement is around
rd S T 13
3 Others MONTH
J
u
J
u
A
u
e
O
c
N
o
D
e
J
a
F
e
M
a
A
p
o activities
14
Participates when being dressed (e.g.
p t
Father’s Name: S n l g
t
t v c n b r r
a
TOTAL SCORE raises arms or lifts leg)
. . . . . . . . . .
Occupation: Educational Attainment: . l 15 Pulls down gartered short pants
No. of
Mother’s Name: School Days Assessment 16 Removes under shirt (sando)
FINE MOTOR DOMAIN
No. of Days 1st 2nd 3rd
Occupation: Educational Attainment: Presents Dresses without assistance except for
Uses all 5 fingers to get food/toys placed 17
buttons and tying
Age of mother when she had the child: No. of Times
Tardy
1
on flat surface
Dresses without assistance including
Number of Children: Picks up objects with thumb and index 18
2 buttons and tying
finger
Informs the adult only after he has
CERTIFICATE OF TRANSFER 3 Display a definite hand preference 19 already urinated (peed) or moved his
Dear Parent,
Admitted to Level/Grade: Section: 4 Puts small objects in/out of containers bowels (poo) in his underpants
This report card shows the ability and progress your Holds crayon with all the fingers of his Informs adult of need to urinate (pee) or
child has made in the different domains as well as his/her Eligible for Admission to Level/Grade: 5
hand making s fist (i.e.., palm grasp) 20
move bowels (pooh-pooh) so he can be
progress in character and psychomotor development. brought to a designated place (e.g.
Unscrews lid of container or unwraps
This school welcomes you if you desire to know 6 comfort room)
Approved: food
more about the progress of your child. Goes to the designated place to urinate
Principal II 7 Scribbles spontaneously (pee) or move bowels (poo) but
21
8 Scribbles vertical and horizontal lines sometimes still does this in his
GERALDINE M. DE GUZMAN CANCELLATION OF ELIGIBILTY TO TRANSFER 9 Draws circle purposely
underpants.
Teacher
Goes to the designated place to urinate
Admitted in: 10
Draws a human figure (head, eyes, 22 (pee) or move bowels (poo) and never
FE A. AÑO trunk, arms, hands/fingers)
Principal II Date: does this in his underpants anymore.
11 Draws a house using geometric forms Wipes/cleans self after a bowel
23
TOTAL SCORE movement (poo)
 Bathing sub-domain: Assessment Plays alone but likes to be near familiar adults ASSESSMENT 1st 2nd 3rd
COGNITIVE DOMAIN 3
1st 2nd 3r d or brothers and sisters
24
Participates when bathing (e.g. rubbing Date of Assessment
arms with soap) 1 Looks at direction of fallen object 4 Laughs or squeals aloud in play
Child’s Age
25
Washes and dries hands without any 2 Looks for partially object hidden 5 Plays peek-a-boo (bulaga)
help Sc Sc Sc
Imitates behavior jest seen a few Rolls ball interactively with Ra Ra Ra
3 6 ale ale ale
26 Washes face without any help minutes earlier caregiver/examiner w w w
d d d
Learning Domains Sc Sc Sc
27 Bathes without any help 4 Offers object but will not release it 7 Hugs or cuddles toys Sc Sc Sc
or or or
TOTAL SCORE Demonstrates respect for elders using terms or or or
5 Looks for completely hidden object 8 e e e
like “po” and “opo” e e e
Exhibits simple pretend play (feed, put
Assessment
6
doll to sleep) 9 Shares toys with others 1. Gross Motor (13) 13
RECEPTIVE LANGUAGE DOMAIN 1st 2nd 3r Imitates adult activities (e.g., cooking, 2. Fine Motor (11)
7 Matches object 10
d washing) 3. Self-Help (27)
8 Matches 2-3 colors
Points to family member when asked to 11 Identifies feelings in others 4. Receptive Language(5)
1
do so 9 Matches pictures Appropriately uses cultural gestures of 5. Expressive Language(8)
2
Points to 5 body parts on himself when 10 Sorts based on shapes 12 greeting without much prompting (e.g., 6. Cognitive (21)
asked to do so mano/bless, kiss, etc.
Sorts objects based on 2 attributes 7. Social-Emotional (24)
Points to 5 named pictured objects 11
3 (e.g., size and color) 13 Comforts playmates/siblings in distress SUM OF SCALED SCORE
when asked to do so
Arranges objects according to size from Persists when faced with a problem or STANDARD SCORE
Follows one-step instructions that 12 14
smallest to biggest obstacles to his wants
4 include simple prepositions (e.g., in, on, INTERPRETATION
under, etc.) 13 Names 4-6 colors 15
Helps with family chores (e.g., wiping tables,
Follows 2-step instructions that include watering plants, etc.)
5
14 Copies shapes
simple prepositions 16
Curious about environment but knows when
15
Names 3 animals or vegetables when to stop asking questions of adults
TOTAL SCORE asked Interpretation of Standard Score
17 Waits for turn
16
States what common household items
Assessment are used for 18
Asks permissions to play with toy being used Standard Score Interpretation
EXPRESSIVE LANGUAGE DOMAIN by another Suggest significant delay in
1st 2nd 3rd 17 Can assemble simple puzzles 69 and below
19 Defends possessions with determination overall development
1 Uses 5-20 recognizable words Demonstrates an understanding of
Plays organized group games fairly (e.g, does Suggest slight delay in
2 Uses pronouns (e.g. I, me, ako, akin) opposites by completing a statement 20 70 - 79
18
not cheat in order to win) overall development
(e.g., “Ang aso ay malaki, at ang daga
Uses 2-3 words verb-noun combinations ay _____”) Can talk about difficult feelings (e.g., anger, Average overall
3 21 80 -119
(e.g. hingi gatas) sadness, worry) he experiences development
19 Points to left and right sides of body
4 Names objects in pictures Honors a simple bargain with caregiver (e.g., Suggest slightly advanced
Can state what is silly or wrong with 120 – 129
22 can play outside only after cleaning/finishing development
5
Speaks in grammatically correct 2-3 20 pictures (e.g., Ano ang mali sa larawang
word sentences his room) Suggest highly advanced
ito?) 130 and above
Watches responsibly over younger development
6 Ask “what” questions 21 Matches upper and lower case letters 23
siblings/family members
7 Ask “who” and “why” questions TOTAL SCORE Cooperates with adults and peers in group
24
Gives account of recent experiences situations to minimize quarrels and conflicts
8 (with prompting in order of occurrence TOTAL SCORE
Assessment
using past tense)+ SOCIAL-EMOTIONAL DOMAIN
1st 2nd 3rd
TOTAL SCORE Enjoys watching activities of nearby
1
people or animals INSTRUCTIONS: Put a [ √ ] Present or child is able to do the task
[ ̶ ] Skills are not present or child does not respond
2
Friendly with strangers but initially may
show slight anxiety or shyness