ECCD Checklist Summary

Early Childhood Care and Development (ECCD) Checklist, Child’s Record 1 1
Child’s Handedness (Check appropriate Box) right
both
left
not yet established
Is the child presently studying? (Check appropriate Box) Yes No
If Yes, write name of child’s school / learning center / day care:
Father’s Name: Fathers Age:
Father’s Occupation: Father’s Educational Attainment:
Mother’s Name: Mother’s Age:
Mother’s Occupation: Mother’s Educational Attainment:
Child’s Number of Siblings Child’s Birth Order (1st, 2nd, 3rd, etc.):
(Brother/s and Sister/s):
Sociodemographic Profile
Indicate the complete sociodemographic profile of the child.
Child’s Name: Sex: Date of Birth:
month day year
Address:
Barangay Municipality/City Province Region

Early Childhood Care and Development (ECCD) Checklist, Child’s Record 1
2
Assessment
No. Year Month Day Examiner’s Name
0-4
months
Date Tested
Child’s Date of Birth
Child’s Age
5-8
months
Date Tested
Child’s Age
9-12
months
Date Tested
Child’s Age
13-18
months
Date Tested
Child’s Age
19-24
months
Date Tested
Child’s Age
25-36
months
Date Tested
Child’s Age
Introducing the Checklist
Introduce the Checklist to the parent/caregiver bysaying the following:
We are here to help you find out how your child is developing by asking you some questions about the
things he is able to do or having your child do some activities. There is no pass or fail score. This is just a
checklist. Some of the questions are for children older than your child so I do not expect him to be able to
do all the things I will be asking.
We plan to administer this Checklist several times until your child is 6 years old. So please do not teach
or coach him because it is important to know just what he can and cannot do at this age.
Later on we will share the results with you and give suggestions on what else you can do to stimulate your
child’s development.
Afterrapport has been established, introduce the Checklist to the child aged 1.0 year or older bysaying the
following:
I will be asking you to do some things for me today. Some of them will be very easy. Some of them may be
a little hard for you. Do not worry if you cannot do them all because some of the activities are for children
who are a little older than you. So I do not expect you to be able to do everything I ask. Just try your best.
It is recommended that the Checklist be administered to the child at six intervals.
Once every four months from ages 0 to 12 months; and once every six months from
ages 13 to 36 months (1 year 1 month to 3.0 years).
Computation of the Child’s Age
After verifying the dates, compute the child’s age by subtracting his birthday from the date the test is administered. Assume that
each month is composed of 30 days. Therefore, do not round off the months or years. Write the examiner’s name each time the
test is administered.

This form can be used for six separate evaluations of the same child so it will be easy for you to see
howhe is developingas he grows older. The“Present” portion ofthis Form has 6 columns where you
are to mark the child’s skills and behavior each time you assess him. If the child exhibits the skill or
behavior, put a check () in the designated column. If the child does not, put a hyphen (-) and
write additional information in the “Comments” column explaining why.
Whereto start andstop
Forinfants aged 0 month to 1.0 year:
The first fewitems in each domain pertains to infants or children from 0 to 1.0 year. These are those
in the “Infants Section.” Administer all these items. Then continue administering the rest of the
items in the domain, including those in the Section labeled “Optional starting point for children aged
1 year and 1 month to 3.0 years” .
Stop only after five consecutive items in each domain havebeen marked withahyphen (-).
Forchildren aged 1 year 1 month to 3.0 years:
Youmaystart with the section labeled “Optional starting point for children aged 1 year and 1 month
to 3.0 years” if the child is 1 year and 1 month old or older and youobserve that he is able to do all
the items enumerated in the “Infants Section.” But if he is not yet able to do the Infant items, then
always start with Item # 1 of each domain.
Administer all the items in this “Optional” section.
Howto score
Tally the number of check marks () in each domain and record this in the section
labeled “Total Score.” If you choose to skip the Infants Section, you still have to place a
check on the items in that section. They are to be counted when you add up the scores
for each domain.
How to Administer

4
Gross Motor Domain
A.Infants Section (Ages 0 month - 1.0 year)
Gross Motor Material/Procedure Present Comments
1. Infant lifts head
when held standing
PROCEDURE:
Hold the child in an upright position and
carefully remove your hand from the child’s
neck according to his ability to lift his head
and keep it erect. Credit if the child
occasionally lifts his head free of support.
Parental report will suffice.
1st 2nd 3rd 4th 5th 6th
2. Infant tries to lift
head when lying on
stomach
PROCEDURE:
Place the child on his stomach on a flat
surface. Credit if the child at least
momentarily lifts his head so that the chin
is off the surface. Parental report will
suffice.
3. Infant holds head
uprighton his own
when lyingon
stomach
PROCEDURE:
Place the child on his stomach on a flat
surface. Credit if the child lifts his head
and chestup sothathisfacemakes a90°
angle w/ the surface for at least several
seconds.Parentalreport will suffice.
4. Infant holds head
steadily
5. Infant rolls over from
his backto his
stomach with
assistance
PROCEDURE:
Placethechildonhisbackonaflatsurface.
Encourage him to roll over to his stomach,
providing some assistance to do so. Credit
if he eventually rolls over. Parental
reportwill suffice.
6. Infant turns from his
sideto hisback
withoutassistance
PROCEDURE:
Roll the child from his back to his side.
Make sure he is not restricted b
y his clothes
and his arm is not caught under his torso.
Credit if the child actively turns from his
side to his back. Parental report will
suffice.
7. Infant sits well with
support, leaning on
hands ifplaced on
hardsurface
PROCEDURE:
Hold the child in a sitting position on the
table and slowly remove your hand from the
child making sure that he does not fall.
Credit if the child sits alone and puts his
hands on his legs or on the table for
support. Parental report will suffice.

8. Infant bounces
when held standing,
brieflybearing
weightonlegs
9. Infant sitsalone
steadily
PROCEDURE:
Hold the child in a sitting position on the
table and slowly remove your hand from him
making sure that he does not fall. Credit if
the child sits alone steadily without
support, keeping his back fairly straight.
10. Infant moves from
sitting to creeping/
crawling position
MA
TERIA
L
:any toy
PROCEDURE:
Seatthe child onthe floor. Placea toyon
the floor, in front of the child, but not
withinhis reach. Observe howthe child
moves fromsittingto creeping position
and the type ofmovement he makes to
reach for the toy. Credit if the child
moves forward about 9 inches ormore,
using either of the following: hands and
knees, stomach and arms, hands and
feet. Parental report will suffice.
11. Infant pullsself
from sitting to
standing position
with minimal
assistance
PROCEDURE:
Withthe child in a sitting position, hold
bothhis hands and havehimpullhimself
up with onlyminimal assistance from the
adult. Credit if the child can stand up.
12. Standswith
minimum support
MA
TERIA
L
:elevated pieceoffurniture
PROCEDURE:
Credit ifthe child holds on to a piece of
furniture with bothhands and bears weight
on bothfeet. Parental report will
suffice.

6
B. Optionalstartingpointforchildrenaged1year1month-3.0years
13. Holdsfurniture with
both hands and
walkssideways
M
A
TE
R
I
A
L
: toy
PROCEDURE:
Whilethe childis standing, observeifhe
movesfromone point to another by
walking sideways.Hemaysupporthimself
byholdingon to furniture. Hecan be
encouragedto walk byplacinga toyon
the furniture near the child but just
outside hisreach so he must walk to
reach the toy.Credit if the child walks
sideways while holding on to furniture
for support and balance. Parental
report will suffice.
14. Walkswith both
hands held
PROCEDURE:
Observethechild ifhe walkswhen both
hands are held byan adult. Credit if the
child takes coordinated walking steps
with only slight support from the adult.
15. Climbsonchair or
anotherelevated
pieceoffurniture
like a bed without
help
16. Walksalone,rarely
falls
PROCEDURE:
Observethechildifhe walks aloneacross
the room. Credit if the child walks
alone with good balance without
tripping and rarely falling. Parental
17. Walksbackwards PROCEDURE:
Askthe child to walk backwards by
demonstrating it. Credit if the child is
able to walk backwards without falling
and holding on to anything. Parental
18. Runs without
tripping or falling
M
A
TE
R
IA
L
: ball
PROCEDURE:
Encourage the child to run byrollinga
ballacross the floor. Credit if the child
can run fast and smoothly without
tripping or falling.
19. Walksdownstairs, 2
feet oneach step,
with one hand held

20. Walksupstairs
holding handrail, 2
feet oneach step
M
A
TE
R
IA
L
: toy
PROCEDURE:
Placea toyin the middle ofthe step and
ask the child to walk up the stairs to get
the toy. Credit if the child walks up the
stairs using the handrail or wall for
support and places both feet on each
step before stepping on the next one.
21. Walksupstairs with
alternate feet
without holding on
to the handrail
M
A
TE
R
IA
L
: toy
PROCEDURE:
Placea toyin the middle ofthe step and
ask the childto walk upstairs to getthe toy.
Credit if the child walks upstairs,
alternatinghis feet as he steps on each
successive step without holding on to
the handrail or wall for support.
22. Walksdownstairs
withalternate feet
without holding
ontoa handrail
M
A
TE
R
I
A
L
: toy
PROCEDURE:
Placea toyat the bottomofthe stairs and
ask thechildto walk downstairstogetthe
toy. Credit if the child walks downstairs,
alternatinghis feet as he steps on each
successive step without holding on to
the handrail or wall for support. Donot
give credit if the child places both feet
on the step or uses the handrail or wall
for support.
TOTAL SCORE

8
Fine Motor Material/Procedure Present Comments
1.
Hands of infant are
kept open most of
the time
PROCEDURE:
Observethe infant’s hands. Creditif his
hands are open most of the time.
2.
Infant wavesarms,
moves body at the
sight of a dangling
object/toy
MA
TERIA
L
:dangling object/toy
This must be elicited by the
interviewer.
PROCEDURE:Dangle the toyin front of
the child
3.
Infant brings both
handstogether
toward dangling
object/toy
MA
TERIA
L
:dangling object/toy
interviewer.
4.
Infant reaches for
and holds small toy/
spoon
MA
TERIA
L
S:small toy/spoon
PROCEDURE:
Holda small toy/spoonin your hand and
urge the infant to getit.
interviewer.
Fine Motor Domain
B. Optional starting point for children aged 1year 1 month - 3.0
years
5. Usesallfivefingers to
get food/toys placed
onflatsurface
MA
TERIA
L
:any small toy/object
PROCEDURE:
Seatthe childon the parent’s lap with his
elbows at level with the tabletopand his
hands onthe table or flat surface. Dropa
small toyin front ofhimand attract his
attentionbypointingto the toyor tapping
the table/flatsurface. Credit if the child
picks up the toy, using all five fingers
as if raking.
6. Picks up objectswith
thumb and index
finger
M
A
TE
R
IA
L
:anysmall toyor food
PROCEDURE:
Placea toy/food in front ofthe child and
within hisreach. Attracthisattention by
tapping near the toy/food. Credit if the
child uses the pads of his thumb and
index or forefinger to pick up the toy/
food.
7. Pullstoywith string M
A
TE
R
IA
L
:toywith string
interviewer.

8. Displaysadefinite
hand preference
M
A
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L
: toy
PROCEDURE:
Placethe toydirectlyin front ofthe child at
midline (not to his left or his right) and
ask himto reach for this. Creditif he
uses the same hand two out of three
times. Parental report will suffice.
9. Graspsandtransfers
objectsfrom hand
to hand
MA
TERIA
L
S:2 small toys
PROCEDURE:
Observeifthechildtransfers asmalltoy
fromone hand to the other. Encourage this
bygivingthe child a toyand then present-
ing another toyto the same hand. Credit if
the child transfers a toy from one hand
to the other without using his mouth or
body.
10. Pushesor pullsa
largeobject
M
A
TE
R
IA
L
:Interviewer’s kitor some large
object
PROCEDURE:
Demonstratepushingor pulling alarge
object.
This must be elicited by the inter-
viewer.
11. Putssmall objects
in/out of container
MA
TERIA
L
S:small objects and container
interviewer.
12. Holdscrayon with
allthe fingers ofhis
hand making a fist
(i.e., palmargrasp)
M
A
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R
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L
:crayon
PROCEDURE:
Present childwitha crayon and have him
getthis. Creditifhe holdsitbywrapping
allfivefingers around asifmaking a fist.
AutomaticallyCreditthis item ifhe uses the
tipsofallfivefingers or thetipsofhis
thumb, index, and middle fingers.
interviewer.
13. Unscrews lidof
container or
unwraps food
MA
TERIA
L
S:Container with screw-on top
orwrappedcandy.
interviewer.
14. Scribbles
spontaneously
MA
TERIA
L
S:paper, pencil/crayon
PROCEDURE:
Placea paper and pencil/crayonon the
tableand ask the child to drawanything he
wants without showinghimwhat to do.
Credit if the child uses the tips of his
thumb and any of his other fingertips to
grasp the pencil/crayon and makes
purposeful scribbling marks on the
paper (not accidental marks).
TOTAL SCORE

10
Self-Help Material/Procedure Present Comments
4. Holdsbottleall by
himself
5. Feedsselfwith
finger food(e.g.,
biscuits,bread)
usingfingers
MA
TERIA
L
S:bread, biscuits
interviewer.
6. Helpsholda cup
fordrinking
Note: Thecup should not have a lid or
spout.
7. Feedsselfusing
fingers toeat rice/
viandswithspillage
8. Drinksfroma cup
without help
M
A
T
E
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L
S
: drinking cup, water
interviewer.
9. Feedsselfusinga
spoonwithspillage
10. Getsa drink for
himself without any
help
TOTAL SCORE
Self-Help Material/Procedure Present Comments
1. Infant sucks and
swallows milkfrom
breast or bottle
2. Infant begins to take
solid foods
Askthe caregiver ifthe childcan take
semi-solid or mashed foods.Credit if the
caregiverreports that the child tolerates
these. Write “Noopportunity” in the
comment section if the child has not
been introduced to solid foods.
3. Chewssolid food
well
Self-Help Domain
B.Optional starting point for children aged 1 year 1 month - 3.0 years

ReceptiveLanguage Material/Procedure Present Comments
1. Infant startles to
loudsounds
2. Infant turns eyes/
headtoward sound
M
A
TE
R
IA
L
:rattle
PROCEDURE:
Carrythe child on his backwith one hand
andwiththe other shake a rattle outofhis
range ofvision6 inches fromhis ear.Do
thiscontinuously for 3 secondsand
observewhether hecanturn towardsthe
sound. Credit if the child widens or
moves his eyes from side to side in
search of the sound.
3. Infant watches
mother intently as
she speaks to him
4. Infant smiles at a
familiar voice, like
when hismother
talks to him.
5. Infant stopscrying
when sung to
6. Turnsheadwhen
calledbyname,
makeseyecontact
PROCEDURE:Gobehind the child a few
feet awayand call out his name. Observe if
the child can lookfor youand smile.
7. Understands “no” PROCEDURE:Shake your head and finger
andsay“No-no”. Thensee whether the
child understands this. Credit if the child
stops what he is doing. Parental
8. Imitates adults’
playful sounds like
coughing, lip
smacking
PROCEDURE:Place the child on the
caregiver’s lapwithyoufacingthechild.
Thenmake the followingsounds:cough,
smack lips. Credit if the child makes the
same sound or even just the lip
movements.
9. Followsone step-
command (e.g. give)
whengesturesare
used
MA
TERIA
L
:spoon or any object
PROCEDURE:
Withthe child seated in front ofyou, give
hima spoon then ask for the spoon back
bysaying“GIVEMETHE_(object) .”
with your hand (palm up) toward him.
Credit if the child looks at the object
and hands it over to you even if he
doesnot releasethis immediately.
Receptive Language Domain

12
Re ceptiveLanguage Material/Procedure Present Comments
10. Follows one step-
command without
needforgestures
M
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L
: toy
PROCEDURE:
Placethe toyon the floor and ask the
child to pick this up without pointing to
the toyor using anyother gesture. Credit
if the child picks up the toy.
11. Pointsto a family
member when
asked to do so
PROCEDURE:
Askthe child to point to his mother/
caregiver. Creditif hedoesso.
B. Optional starting point for children aged 1year 1 month - 3.0
years
Rec eptiveLanguage Material/Procedure Present Comments
12. Pointsto fivebody
parts onhimself
whenasked to do
so
PROCEDURE:
Havethe childpoint to hiseyes, nose,
mouth, hands and feet. Credit if he can
point to all these.
13. Pointsto five
namedpictured
objects whenasked
to do so
MA
TERIA
L
:picture book 1
PROCEDURE:
Showthe childa picture book(two
pictures per page) and ask himto pointto
thepicture bysaying“Where’sthe
?”Credit if the child can use
his finger to point to at least five
pictures.
14. Follows one-step
instructionsthat
include simple
prepositions(e.g.,
in, on, under, etc.)
M
A
TE
R
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L
: block/toy
PROCEDURE:
Askthe child to put a block/toy under the
table;on the table; in the bag. Donot
pointor use gestures when givingthe
instruction. Credit if the child is ableto
follow at least one of the instructions.
15. Follows two-step
instructionsthat
include simple
prepositions
M
A
TE
R
IA
L
: block/toy
PROCEDURE:
Askthe child to geta block/toy from
under the table and then place it on the
table. Donotpointor use gestures when
givingthe instruction. Credit if the child
is able to follow.
TOTAL SCORE

Expressive Language Domain
Ex pressiveLanguage Material/Procedure Present Comments
1. Infant vocalizes (e.g.,
gurgles, coos,grunts)
2. Infant vocalizestoexpress
pleasureordispleasure
3. Infant shouts to attract
the attentionof the
caregiver
4. Infant laughs out loud
andsqueals
5. Infant vocalizes different
vowel sounds (e.g., ahh,
oooh)
6. Infant vocalizes other
soundsthat do not mean
anything
PROCEDURE:
Askcaregiver ifthe child can make
two different sounds apart from
crying like“goo”and “er”. Take
note of the sounds. Parental
7. Infant babbles
continuously to amuse
selfor attract attention
8. Infant tries to imitate the
caregiver’s vocalizations
9. Infant uses body
movements/gestures to
make wantsknown (e.g.,
stretches armstoindicate
whathewants)
B. Optional starting point for children aged 1 year 1month - 3.0 years
Ex pressiveLanguage Material/Procedure Pr es ent Comments
10. Repeats vowel-
consonant combinations
withoutreferring to
anything or anyone (e.g.,
baba, mama, dada)
11.
.
Usessoundsmeaningfully
torefer tospecific
objects/persons (e.g.
“Mama”for his mother;
“mamam” forwater)

14
Ex pressiveLanguage Material/Procedure Present Comments
12. Chatters in a
conversational tone
withoutusingreal words.
13. Triesto imitatereal
wordsofadult
14. Combinessingle words
and gesturesto make
wants known (e.g., “out”
while pointingto the
door)
15. Uses 5 to20
recognizable words
PROCEDURE: A
sk the caregiver if the
child can clearly say five to six words
aside from mama and papa. This will
be the minimum number.
16. Uses pronouns (e.g. I,
me, ako, akin)
17. Uses two- to three-word
verb-noun combinations
(e.g., hingi gatas)
18. Names objects in
pictures
MA
TERIA
L
:picture book
PROCEDURE:Showthe child a
picture book, point to an object in
the book, then ask himto name this
(e.g., Ano ito?). Credit if the child
can say the correct name of at
least four objects. Parental
19. Speaksingrammatically
correct two-tothree-
wordsentences
20. Asks“what” questions Parental report will suffice.
21. Asks “who” and“why“
questions
22. Givesaccountofrecent
experiences (with
prompting)in order of
occurrence using past
tense
PROCEDURE:
Askthe caregiver ifthe child can
recountrecent experiences in correct
sequenceandusingpasttenses
correctly.Thecaregiver can prompt
himso he can complete what he is
talking about (e.g., Tapos ano pang
nangyari?). Parental report will
suffice.
TOTALSCORE

Cognitive Material/Procedure Present Comments
1. Infant inspects
surroundings
Credit if the infant looks around the
room.
2. Infant gazesslowly at
moving objects/
people
3. Infant turns head to
brightcolored
objects
4. Infant changes face
whenhe doesnot
like the tasteofhis
food
5. Infant exploresand
manipulates objects
bybiting, holding,
and looking at them
MA
TERIA
L
:clean toy/object
PROCEDURE:
Givethe child a clean toyor objectand
observeifhe brings itto his mouth to bite
orchew.
6. Infant shakes toy
deliberatelyto make
thissound
M
A
TE
R
IA
L
:rattle
PROCEDURE:
Givethe childa rattle and observeifhe
can make it sound. Credit if the child
can hold a rattle and shake it for a few
seconds, hit it on the mat or wave it.
7. Infant eventuallygets
used to irritatingor
bothersome
environmental
sounds(e.g.,
tricycle, crowing of
cock)
PROCEDURE:
Askthe caregiver ifthechildeventually
gets used to environmental sounds like
that ofa tricycle/other vehicles, sound of
animals (chicken, dogs) that mayhave
woken, bothered or irritated himearlier.
8. Infant reacts to cloth
placedoverhisface
MA
TERIA
L
:cloth (handkerchief or face
towel)
PROCEDURE:
Withthe child lying on his back, gently
coverhis face witha paper/cloth and
observe ifhe tries to remove this or pull it
away.
Cognitive Domain
A.Infants Section(Ages 0 month - 1.0 year)

16
9. Looksin the
direction ofa fallen
object
M
A
TE
R
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L
: spoon/ball
PROCEDURE:
Withthe child seated, get his attention and
drop a spoon/ball in front ofhim. Then
observeifhiseyeslookdownasthe object
falls. Credit if the child can bring his eyes
and head down as the object falls.
10. Displaysapreference
for certain objectsby
reaching for these
morereadilythan
others
11. Pushes the ballto
make itroll
M
A
TE
R
IA
L
: ball
interviewer.
12. Repeatedly drops or
throws objects
M
A
TE
R
IA
L
: toy
PROCEDURE:
Whilecarrying the child, hand himthe toy
and see ifhe dropsor throws this as if
fascinated withthe act ofdoingso.
13. Looksforapartially
hidden object
MA
TERIA
L
S:ball, small towel/cloth
PROCEDURE:
Withthe child facing you, partiallyhide a
ballbehind a small toweland observeifhe
will look for it and find it. Credit if the
child pulls the towel and gets the hidden
ball.
14. Imitatesbehavior
seen justafew
minutes earlier
15. Offers object but will
notrelease it
16. Looksforcompletely
hidden object
MA
TERIA
L
S:ball, small towel/cloth
PROCEDURE:
Withthe child facing you,hide a ball
completelyunder a small toweland observe
ifhe willlookunder the towel. Credit if he
looks under the towel and gets the hidden
ball.

17. Exhibitssimple
pretendplay(feeds,
puts dollto sleep)
MA
TERIA
L
S:doll or toycar/block
PROCEDURE:
Ifthe childis a girl, carrythedolland tryto
rock itto sleep. Ifthe childisa boy,move
the toycar/block back and forth. Credit if
the child can imitate this.
18. Matches objects M
A
T
E
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L
S
: pairs of spoons, balls, blocks
PROCEDURE:
Place one spoon, one ball, and one block
on the table. Give the child the other set of
objectsarranged in randomorder.
Demonstrate amatching response(e.g.,
spoon to spoon) then return the objects to
the child. Say,“Puteach objecton the one
that is just like it.” Credit if the child can
match the objects correctly.
TOTAL SCORE

18
Social-Emotional Material/Procedure Present Comments
1. Infant stops crying
when mother picks
him
2. Infant smiles in
response to the
caregiver
3. Infant reacts to
familiar situations
like bathing or
feeding (e.g.,
thrashes about,sucks
vigorouslyatthe sight
ofbottle)
4. Infant lifts arms to
greet familiarpeople
Social-Emotional Domain
A.Infants Section (Age 0 months - 1.0 years)
5. Crieswhencaregiver
leaves
6. Enjoyswatching
activities ofnearby
people or animals
7. Smilesplayfullyat
mirror image
M
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L
:mirror
PROCEDURE:
Withthe child in a sitting position, place
a mirror in front ofhimand observeifhe
stares ator tries togetthemirror or pats
it. Credit if the child can look or smile
at the mirror, kiss or pat it with his
hand or just turn it around.
8. Friendlywith
strangersbut initially
mayshowslight
anxietyorshyness
9. Playsalone but likes
tobenear familiar
adultsorbrothers
andsisters
10. Laughsorsqueals
aloud in play
B. Optional starting point for children aged 1 year and 1 month to 3.0
years

11. Plays peek-a-boo
(bulaga)
12. Rollsball
interactively with
caregiver/examiner
13. Hugsor cuddlestoys Parental report will suffice.
14. Respondswith
pleasure tofriendly
people
TOTAL SCORE

20
Nameofexaminer :
Date administered :
Place where testisadministered :
Tothe examiner :
Please fill outthe spacesbelowfor additionalinformation. Thankyouverymuch.
Writedown your notes, descriptions and observations on the followingpoints:
Child’s background (ex. behavior/health/etc.)
Familyenvironment (ex. Health offamily members/family problems/economic conditions/etc.)
Parents’ stimulating activities for the child (Whatare the activities/thingsthat the parents do to help stimulate the child’s develop-
ment?)
Home environment (ex. Facilities/type ofhouse/ household items/ interaction/etc.)
Others

Domain
Age
1st Evaluation Date:
Child’s Age
2nd Evaluation Date:
Child’s Age
3rd Evaluation Date:
Child’s Age
Raw Score Scaled Score Raw Score Scaled Score Raw Score Scaled Score
Gross Motor
Fine Motor
Self-Help
Receptive Language
Expressive Language
Cognitive
Social- Emotional
Sum of Scaled Scores
Standard Score
Interpretation
Domain
Age
4th
Evaluation Date:
Child’s Age
5th Evaluation Date:
Child’s Age
6th Evaluation Date:
Child’s Age
Raw Score Scaled Score Raw Score Scaled Score Raw Score Scaled Score
Gross Motor
Fine Motor
Self-Help
Receptive Language
Expressive Language
Cognitive
Social- Emotional
Sum of Scaled Scores
Standard Score
Interpretation
Transfer the raw score for each domain to the table below. Using the Scaled Score Equivalent of Raw Scores Table,
convert the raw scores to Scaled Scores appropriate to the age of the child. T
o arrive at the Sum of Scaled Scores, add the
Scaled Scores across all domains. T
o derive the Standard Score, refer to the Standard Score Equivalent of Sums of Scaled
Scores Table. Writethe child’s age on each evaluation.

22
Scaled Scores
Mark an x on the dot corresponding to the Scaled Score for each domain and connect the x’s. Write the child’s age on each
evaluation.
Child’s Age: Child’s Age: Child’s Age:
DOMAIN DOMAIN DOMAIN
SCALED
SCORE
GROSSMOTOR
FINEMOTOR
SELF-HELP
RECEPTIVE
LANGUAGE
EXPRESSIVE
LANGUAGE
COGNITIVE
SOCIAL-EMOTIONAL
SCALED
SCORE
GROSSMOTOR
FINEMOTOR
SELF-HELP
RECEPTIVE
LANGUAGE
EXPRESSIVE
LANGUAGE
COGNITIVE
SOCIAL-EMOTIONAL
SCALED
SCORE
GROSSMOTOR
FINEMOTOR
SELF-HELP
RECEPTIVE
LANGUAGE
EXPRESSIVE
LANGUAGE
COGNITIVE
SOCIAL-EMOTIONAL
Suggests
advanced
development
19
18
17
16
15
14
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
19
18
17
16
15
14
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
19
18
17
16
15
14
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Average
development
13
12
11
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
13
12
11
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
13
12
11
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
10 • • • • • • • 10 • • • • • • • 10 • • • • • • •
9
8
7
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
9
8
7
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
9
8
7
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Re-test
after
3-
6
months
6
5
4
3
2
1
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
6
5
4
3
2
1
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
6
5
4
3
2
1
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•

uggests
advanced
development
Child’s Age: Child’s Age: Child’s Age:
DOMAIN DOMAIN DOMAIN
SCALED
SCORE
GROSSMOTOR
FINEMOTOR
SELF-HELP
RECEPTIVE
LANGUAGE
EXPRESSIVE
LANGUAGE
COGNITIVE
SOCIAL-EMOTIONAL
SCALED
SCORE
GROSSMOTOR
FINEMOTOR
SELF-HELP
RECEPTIVE
LANGUAGE
EXPRESSIVE
LANGUAGE
COGNITIVE
SOCIAL-EMOTIONAL
SCALED
SCORE
GROSSMOTOR
FINEMOTOR
SELF-HELP
RECEPTIVE
LANGUAGE
EXPRESSIVE
LANGUAGE
COGNITIVE
SOCIAL-EMOTIONAL
19
18
17
16
15
14
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
19
18
17
16
15
14
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
19
18
17
16
15
14
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Average
development
S
13
12
11
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
13
12
11
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
13
12
11
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
10 • • • • • • • 10 • • • • • • • 10 • • • • • • •
9
8
7
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
9
8
7
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
9
8
7
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Re-test
after
3-
6
months
6
5
4
3
2
1
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
6
5
4
3
2
1
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
6
5
4
3
2
1
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•

Re-test
after
3
to
6
months
Average
development
Standard Scores
MarkanxonthecorrespondingStandardScoreforeachtestadministrationandconnectthex’s.Writethedateforeachtestadministration.
0-4 months 5-8 months
AGE
9-12 months 13-18 months 19-24 months 25-36 months
160
150
140
130
120
110
100
90
80
70
60
50
40
30
20
Date Tested
24
Suggests
advanced
development
FirstPrinting
January2004
Manila,Philippines
NOTFORSALE

Early Childhood Care and Development (ECCD)
System refers to the full range of health, nutrition,
early education and social services programs that
provide for the basic holistic needs of young children
from birth to age six, to promote their optimum growth
and development.
By using this given checklist, you will be able
to determine if a child is developing adequately, or is
at risk for developmental delays.
NOTE:
This Checklist is NOT intended to be used to 1) make
a medical diagnosis; 2) determine a child's
intelligence quotient or IQ; or 3) gauge his academic
achievement.
SHARED BY:
Ms. Sharifa Almeera Tuahan, LPT
SPED Specialist

ECCD Checklist Summary

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