This document contains information about a Philippine Early Childhood Development Checklist (Form 2) for children ages 3.1 to 5.11 years old. It includes domains that assess gross motor skills, fine motor skills, social-emotional development, self-help skills, receptive language, expressive language, and cognitive skills. For each item, it provides materials needed, procedures for administrators to follow, and space to record the child's performance. The purpose is to help parents and caregivers understand their child's development and provide appropriate care and teaching.

1. SAINT JUDE THE APOSTLE INTEGRATED
SCHOOL, INC.
#204 SUMULONG HIGHWAYBRGY. MAYAMOTANTIPOLO CITY
Contact No.: 09279564720 Email Address: stjudeantipolo@gmail.com
PHILIPPINE EARLY CHILDHOOD
DEVELOPMENT CHECKLIST
Child’s Record Form 2
(3.1 - 5.11 years old)
Child’s Name: ______________________________________________
Child’s Birthday: ______________________
Address:
Barangay: ___________ Municipality:____________Province: ____________
Sex: Male Female
Handedness : Right Left
Is the child presently studying? YES NO

2. Father’s Name: _________________________________
Mother’s Name: _________________________________
To the Parents:
The Philippine Early Childhood Development Checklist (Form 2) contains knowledge,
skills and attitudes of children 3.1 to 5.11 years old. This may be used as guide in
knowing your child and consequently giveappropriatecareand teachingto guide their
growth and development.
GROSS MOTOR DOMAIN
No. SOCIAL -EMOTIONAL DOMAIN
MATERIALS/
PROCEDURE
BoSY EoSY
1 Climbs on chairor other
elevatedpieceoffurniture like
a bed without help
Parental report
will suffice
2 Walks backwards
Runs without tripping or falling
MATERIAL: toy
PROCEDURE:
Ask the childto
walk backwards by
demonstrating
this. Credit ifthe
child is able to
walk backwards
without fallingand
holdingon to
anything.
Parental report
will suffice
3 Walk downstairs, 2feeton
each step,with onehandheld
MATERIAL: ball
PROCEDURE:
Encourage the
child to run by
rolling a ball across
the floor. Credit if
the child can run
fast and smoothly
without trippingor
falling.
4 Walk upstairs holding
handrail,2 feet oneachstep
Parental report
will suffice.
5 Walk upstairs withalternate
feet without holding handrail
MATERIAL: toy
PROCEDURE: Place
a toy in the middle
ofthe 4th or 5th
step andask the
child to walk up
the stairs to get
the toy. Credit if
the child walks up

3. the stairs using the
handrailor wallfor
support andplaces
both feet on each
step before
stepping on the
next one.
Parental report
will suffice.
6 Walk downstairs with alternate
feet without holding handrail
MATERIAL: toy
PROCEDURE: Place
a toy in the middle
ofthe step and ask
the child towalk
upstairs to getthe
toy.
Credit ifthe child
walk upstairs,
alternatinghis feet
as he steps on
each successive
steps without
holdingonto the
handrailor wallfor
support.
Parental report
will suffice.
7 Moves body part as directed MATERIAL: toy
PROCEDURE: Place
a toy at the
bottom ofthe
stairs and askthe
child to walk
downstairs toget
the toy.
Credit ifthe child
walks downstairs,
alternatinghis feet
as he steps on
eavh successive
step without
holdingonto the
handrailor wallfor
support. Donot
give credit ifthe
child places both
feet on the step or
uses the handrail
or wall for support.
Parental report
will suffice.
8 Moves body parts as directed PROCEDURE:
Ask the childto
raise both arms.
9 Jumps up This must be
elicited by the
interviewer.
10 Throws balloverhead with
direction
MATERIAL: ball
PROCEDURE: Give
the ball tothe
child andstand at
least 3feetaway
from him. Ask the
child to throw the
ball to you using
an overhand
throw. You may
show the child
how to do it.
Credit ifthe child
throws the ball
within your arm’s
reach between
your knees and
head using an
overhand throw
and not sideways
or underhand.
11 Hops 3 steps on preferred foot PROCEDURE: Ask
the child tolift his
foot and hop at
least 3times on his
preferred foot.
Credit ifthe childis
able to hop atleast
3 times on his
preferred foot
without holdingon

4. to anything.
12 Jumps and turns PROCEDURE: Ask
the child tojump
while making a
half-turn. Creditif
the child is able to
do this without
trippingor falling.
13 Dances patterns/joins group
movementactivities
Parental report
will suffice.
TOTAL SCORE
FINE MOTOR DOMAIN
No. FINEMOTOR DOMAIN MATERIALS/
PROCEDURE
BoSY EoSY
1 Uses all 5 fingers toget
food/toys placedon a flat
surface
MATERIAL: small
toy/object
PROCEDURE: Seat the
child on theparents
lap with his elbows at
level with the
tabletop or flat
surface.Dropa small
toy in front ofhim
and attract his
attentionby pointing
to the toy or tapping
the table/flatsurface.
Credit ifthe childpicks
up the toy, using all 5
fingers as ifraking.
Automatically credit
ifhe passes thenext
item.
2 Picks up objects with thumb MATERIAL: small
and indexfinger. toy/food
PROCEDURE: Placea
toy/food in front of
the child andwithin
his reach. Attracthis
attentionby tapping
near the toy/food.
Credit ifthe childuses
the tips o his thumb
and index finger or
forefinger to pick up
the toy/food.
3 Displays a definitehand
preference
MATERIAL: toy
PROCEDURE: Place
the toy directly in
front ofthe child at
mid line (notto his
left or his right) and
ask him to reachfor
this.
Credit ifhe uses the
same hand 2 outof3
times.
Parental report will
suffice.
4 Puts smallobjects in/outof
containers
MATERIAL: small
objects,container
Thismust be elicited
by the interviewer.
5 Holds crayonwith allthe
fingers ofhis hand as though
making a fist (i.e.,palmargrasp)
MATERIAL:crayon
PROCEDURE: Present
the child witha
crayon andhavehim
get this.
Credit ifhe holds it by
wrappingallfingers
around as ifmaking a
fist. Automatically
credit this item ifhe
uses the tips ofall 5
fingers or his thumb,
index and middle

5. fingers.
This must beelicited
by theinterviewer.
6 Unscrews lid of container or
unwraps food
MATERIAL: Container
with screw-on top or
wrapped candy.
This must beelicited
by theinterviewer.
7 Scribbles spontaneously MATERIAL: paper,
pencil/crayon
PROCEDURE: Placea
paper and
pencil/crayonon the
table and ask the
child to draw
anything he wants
without showing him
what to do.
Credit ifthe childuses
the tips ofhis thumb
and any ofhis other
fingertips to graspthe
pencil/crayon and
purposefully scribbles
on the paper (not
accidentally)
8 Scribbles verticaland horizontal
line
MATERIAL: paper,
pencil/crayon
PROCEDURE: Placea
paper and
pencil/crayonon the
table or flat surface
and ask the child to
draw vertical and
horizontal lines after
you have
demonstrated these
to him.
Credit ifthe child
produces a vertical or
horizontal line that is
at least 2 inches long
and does not deviate
or vary from your
vertical line bymore
than 30 degrees. The
lines may be wavy but
not broken.
9 Draws circle purposely MATERIALS: paper,
pencil/crayon
PROCUDURE: Placea
paper and
pencil/crayonon the
table or flat surface
and ask the child to
draw a circleafteryoy
have demonstrateit
to him. Creditifthe
child produces any
curve that is closed or
nearly closed.
Continuos spiral
motions arenot
credited.
10 Draws a human figure(head,
eyes,trunk,arms, hands/fingers)
MATERIALS:
paper,pencil
PROCEDURE: Give the
child a pencilanda
paper and ask him to
draw a picture ofa
person.
Credit ifthe childhas
drawn 3 or more body
parts. Apair is
considered one part
(eyes, arms, hands,
legs and feet) and
must be drawn in
pairs to get fullcredit
unless the drawingis
in profile.
11 Draws a houseusing geometric
forms
MATERIALS: paper,
pencil
PROCEDURE:
Give the childa pencil
and paper and ask
him to draw a picture
ofa house. Creditif

6. the child has drawn at
least the roof, main
frame, and a door or
window.
TOTAL SCORE
SELF-HELP DOMAIN
No. SELF-HELP DOMAIN MATERIALS/
PROCEDURE
BoSY EoSY
1 Feeds self with fingerfoods
(e.g. biscuits,bread using
fingers)
MATERIALS: bread,
biscuits.
This must be elicited
by the interviewer.
2 Feed self using fingers to eat
rice/viands with spillage
Parental report will
suffice.
3 Feed self using spoon with
spillage
Parental report will
suffice.
4 Feeds self using fingers without
spillage
Parental report will
suffice.
5 Feeds self using spoonwithout
spillage
Parental report will
suffice.
6 Eats without need for spoon
feeding during any meal
Parental report will
suffice.
7 Helps hold cup for drinking Note: The cup should
not have a lid orspout
8 Drinks from cup with spillage Ask the caregiverif
the child candrink
from a cup/glass with
some spillage.. The
cup shouldnothave a
lid or spout.
9 Drinks from cup unassisted MATERIALS: drinking
cup,water
This must be elicited
by the interviewer.
10 Pours from pitcherwithout
spillage
Parental report will
suffice.
11 Prepares own food/snack Parental report will
suffice.
12 Prepares meals for younger
siblings/family members when
no adult is is around
Ask the caregiverif
the child canprepare
his own snack without
help exceptfor
getting items thatare
hard to reach(e.g
bowl,spoon)
13 Participates when being
dressed (e.g.raises arms orlift
legs)
Parental report will
suffice
14 Pulls down gartered shorts
pants
Parental report will
suffice
15 Pulls down gateredshortor
pants
Parental report will
suffice
16 Removes sando Parental report will
suffice
17 Dresses without assistance,
except buttoning and tying
Parental report will
suffice
18 Dresses without assistance,
including buttoning andtying
Materials: smallshirt
with buttonor
shoestring
PROCEDURE: Have
the child demonstrate
how to buttonin
order to creditthis
item.
19 Informs adultonly after hehas
already urinated (peed) or
moved his bowels (poohed) in
his underpants
Parental report will
suffice
20 Informs the adultofneed to
urinate (pee) or movebowels
(pooh-pooh)sohe canbe
Parental report will
suffice

7. brought to designated place
(e.g. comfort room)
21 Goes to thedesignated placeto
urinate(pee) or move
bowels(pooh) andsometimes
still does this in his underpants
Parental report will
suffice
22 Goes to thedesignated placeto
urinate(pee) or move
bowels(pooh) andnever does
this in his underpants anymore
Parental report will
suffice
23 Wipes/Cleans selfaftera vowel
movement(pooh)
Parental report will
suffice
24 Participates when bathing (e.g.
rubbing arms withsoap)
Parental report will
suffice
25 Washes and dries hand without
any help
Ask the caregiverif
the child canwash
and dry his hand
without any helpor
supervision except to
turn on/offfaucets
that areout ofreach.
26 Washes facewithout any help Ask the caregiverif
the child canwash
and dry his face
without any helpor
supervision except to
turn on/offfaucets
that areout ofreach.
27 Bathes without any help Parental report will
suffice
TOTAL SCORE
RECEPTIVE LANGUAGE DOMAIN
No. RECEPTIVELANGUAGE
DOMAIN
MATERIALS/
PROCEDURE
BoSY EoSY
1 Points to family member when PROCEDURE: Ask the
child to point tohis
asked to doso mother/caregiver.Cre
dit ifhe does so.
2 Points to 5bodyparts on
himselfwhenasked todo so
PROCEDURE: Have
the child point tohis
eyes, nose, mouth,
hands, and feet.
Credit ifhe can point
to all ofthese.
3 Points to 5named pictured
objects when askedto do so
MATERIAL: picture
book
PROCEDURE: Show
the child a picture
book
(2pictureperpage)
and ask him topoint
to the pictureby
saying “Where’s the
____?
Credit ifthe childcan
use his finger to point
to at least 5 pictures.
4. Follows one-step instructions
that includesimple
preparations (e.g.,in,on under
etc.)
MATERIALS: block/toy
PROCEDURE: Ask the
child to putthe
block/toy underthe
table:onthetable;in
the bag. Do notpoint
or use gestures when
giving the
instructions. Credit if
the child is able to
follow at leastone of
the instructions.
5 Follows 2-step instructions that
include simpleprepositions
MATERIALS: block/toy
PROCEDURE: Ask the
child to get a
block/toy from under
the tableand then
place iton thetable.
Do not point oruse
gestures whengiving
the instruction.
Credit ifthe childis

8. able to follow.
TOTAL SCORE
EXPRESSIVE LANGUAGE DOMAIN
No. EXPRESSIVELANGUAGE
DOMAIN
MATERIALS/
PROCEDURE
BoSY EoSY
1 Use 5-20 recognizable words PROCUDEURE: Ask
the caregiver ifthe
child canclearly say 5
to 6 words asidefrom
“mama”and “papa”.
This will bethe
minimum number
2 Uses pronouns (e.g., I,me,ako,
akin)
Parental report will
suffice.
3 Use 2-3 word verb-noun
combinations (e.g hingigatas)
Parental report will
suffice.
4 Names objects inpictures MATERIALS:
Picture book
PROCEDURE:
Show the child a
picture book, point to
an objectin the book,
then ask him toname
it (e.g., Ano ito?)
Credit ifthe childcan
say the correct name
ofat least 4 objects.
5 Speaks ingrammatically correct
2-to-3 word sentences
Parental report will
suffice.
6 Asks “whatquestions” Parental report will
suffice.
7 Asks “who” and“why”
questions
Parental report will
suffice.
8 Gives accountof recent
experiences (with prompting)
PROCEDURE: Ask the
caregiver ifthechild
in order ofoccurrence using
past tense
can recount recent
experiences incorrect
sequenceandusing a
past tenses correctly.
The caregiver can
prompt him so hecan
completewhathe is
talking about (e.g.
tapos, ano pang
nangyari)
Parental report will
suffice.
TOTAL SCORE
COGNITIVE DOMAIN
No. COGNITIVEDOMAIN MATERIALS/
PROCEDURE
BoSY EoSY
1 Looks at directionofa fallen
object
MATERIALS:
spoon/ball
PROCEDURE: With the
child seated, gethis
attentionanddropa
spoon/ballin front of
him. Then observeif
his eyes look downas
it falls.
Credit ifthe childcan
bring his eyes and
head down as the
objects falls.
2 Looks for a partially hidden
object
MATERIALS: ball,small
towel/cloth
PROCEDURE: With the
child facing you,
partially hide a ball
behind a small towel
and observeifhe will

9. look for it and find it.
Credit ifthe childpulls
the towel ang gets the
hidden ball.
3 Imitates behavior justseena
few minutes later
Parental report will
suffice.
4 Offers on object butmay not
releaseit
Parental report will
suffice.
5 Looks for completelyhidden
objects
MATERIALS: ball,small
towel/cloth
PROCEDURE: With the
child facing you, hide
a ball completely
under a smalltowel
and observeifhe will
look under the towel.
Credit ifhe looks
under the toweland
gets the hidden ball.
6 Exhibits simple “pretend” play
(feeds, puts dollto sleep)
MATERIALS: doll or
toy car/block
PROCEDURE: Ifthe
child is a girl, carry the
doll and pretend to
rock it to sleep. Ifthe
child is a boy,move
the toy car/block back
and forth. Creditifthe
child canimitate this.
7 Matches objects MATERRIALS: pairs of
spoon,balls,blocks
PROCEDURE: Place1
spoon, 1 ball, and 1
block on the table.
Give the childthe
other setofobjects
arrangedin random
order. Demonstratea
matching response
(e.g. spoon to spoon)
then return the
objects to thechild.
Say “Put eachobject
on the one hat is just
like it” Creditifthe
child canmatch the
objects correctly.
8 Matches 2 to 3 colors MATERIALS: 3 pairs of
crayons (blue, red,
yellow) PROCEDURE:
Place 1 crayon ofeach
color on thetableor
flat surface. Givethe
child the other
crayons arrange in
random order.
Demonstratea
matching respose
(e.g. red crayon with
another red
crayon)then return
the crayons to the
child. Say,“Put each
crayon on theone
that is justlike it”.
Credit ifthe child
match.
9 Matches picture MATERIALS: 3 pairs of
picture cards (e.g.,
pictures ofanapple,
orange,banana)
PROCEDURE: Place
one copy ofeach
picture onthetable or
flat surface. Givethe
child the other
pictures arranged in
random order.
Demonstratea
matching response
(e.g., pictureofan
apple with another
apple. Thenreturn
the pictures tothe
child. Say’“Put each
picture ontheone
that justlike it.”Credit
ifthe child can match
all the pictures
correctly.
10 Sorts basedon shapes MATERIALS: Pairs of
different shapes that
are ofthe samesize

10. and color.
PROCEDURE: Show
the child theshape.
Tell the child, “Put
together the ones
that arethesame”.
After the child sorts
and groups the
shapes, point to the
ones withsameshape
and ask. “Whydidyou
put thesetogether?
Credit ifthe childcan
group the same
shapes and say why
they are the
same(Pareho silang
hugis/shape, purosila
bilog)
11 Sorts objects basedon 2
attributes (e.g., sizeand color)
MATERIALS: 4 pairs of
the sameshapethat
differ in size and
color: 2 sizes, 2 colors.
PROCEDURE: Show
the child theshapes,
Tell the child, “Put
together the ones
that arethesame”.
Credit ifthe childcan
sort all the shapes
accordingto size and
color.
12 Arrange objects according to
size from smallest tobiggest
MATERIALS: 4 pieces
ofgraduated sized
squares and4 pieces
ofgraduated sized
circles. PROCEDURE:
Show the child the
first set ofsquares
spread out at random
on a tableor flat
surface.Say,“Here
are 4 squares. Look,I
can begin withthe
smallest,then move
to the next big one,
until I reachthe
biggest one.
Demonstratehowto
arrange the squares.
Then disarrangethese
and tell thechild,
“Now you start with
the smallest,put to
the next oneand the
next big one until the
last one. Repeatthis
procedure. Using the
circles without
demonstrating. Credit
ifthe child arranges at
least one set of
shapes in correct
order from smallest to
biggest. Allow one
trial for eachset of
shapes.
13 Names 4 to6 colors MATERIALS: 6 papers
ofdifferent colors
PROCEDURE: Ask the
child “Whatcolor is
this? “Creditifthe
child ifthe child can
name 4 to 6 colors
correctly.
14 Copies shapes MATERIALS: Paper
and pen/crayon
PROCEDURE: Let the
child copy a circle,
triangle, and square
after demonstrating
how each ofthese is
done.
15 Name 3 animals or vegetables
when asked
Credit ifthe childcan
name 3 animals or
vegetables.
16 States what common
household items are used for
Credit ifhe can state
the use offunction of
at least 2 household
items like a bed anda
drinkingglass.
17 Can assemblesimplepuzzles MATERIAL: 4 to 6
simple puzzles

11. 18 Demonstrates an
understanding ofopposites by
completing a statement
(e.g. “Ang aso ay malaki, ang
daga ay ____________” )
Credit ifthe chikd can
give an opposite
word.
19 Points to left andrightsides of
body
PROCEDURE: Sit
across thechildand
ask, “Showme your
left hand”. Do the
same for the
following: Right hand,
Left foot, right knee,
left shoulder, right
eye, right knee,left
leg. Credit ifthe child
can correctlypointout
the left and right side
on at least 5 body
parts as requested.
20 Can state what is silly orwrong
with pictures (e.g. Ano angmali
sa larawangito?)
MATERIALS: a picture
PROCEDURE: Show
the picturedscenes to
the child oneat a time
and ask, “Whatis
wrong with this
picture?”Credit ifthe
child correctly
identifies whatmade
the picture incorrect.
21 Matches upper andlower case
letters
MATERIALS: Alphabet
cards with upper and
lower caseletters
TOTAL SCORE
SOCIAL-EMOTIONAL DOMAIN
No. SOCIAL-EMOTIONAL DOMAIN MATERIALS/
PROCEDURE
BoSY EoSY
1 Enjoys watching activities of
nearby people oranimals.
Parental report will
suffice.
2 Friendly with strangers but
initiallymay show slightanxiety
or shyness
Parental report will
suffice.
3 Plays alone but likes to benear
familiar adults or brothers and
sisters
Parental report will
suffice.
4 Laughs or squeals aloudin play Parental report will
suffice.
5 Plays peek-a-boo (bulaga) Parental report will
suffice.
6 Rolls ball interactively with
caregiver/examiner
Parental report will
suffice.
7 Hugs or cuddles toys Parental report will
suffice.
8 Demonstrates respect for
elders using terms like“po” and
“opo”
Parental report will
suffice.
9 Shares toys withothers Parental report will
suffice.
10 Imitates adultactivities
(e.g.,cooking, washing)
Parental report will
suffice.
11 Identifies feelings in others Credit ifthe childcan
tell when the
caregiver is feeling
happy, sad, worried,

12. etc.
Parental report will
suffice.
12 Appropriately uses cultural
gestures of greeting without
much prompting (e.g.,mano,
bless,kiss etc.)
Parental report will
suffice.
13 Comforts playmates/siblings in
distress
Parental report will
suffice.
14 Persists when faced with a
problem or obstacleto his
wants
Credit ifthe childtries
to solve problem
instead ofcrying
when something
stands in the way of
what he wants (e.g.,
fastening a boxofhis
treasures with a string
ifthe lid no longer
closes).
15 Helps with family chores (e.g.,
wiping tables, watering plants
etc.)
Parental report will
suffice.
16 Curious about environmentbut
knows whento stopasking
questions of adults
Credit ifthe childasks
questions about
things aroundhim but
knows when he is
being “makulit”about
the topic.
Parental report will
suffice
17 Wait for his/her turn Parental report will
suffice.
18 Asks permissionto playwith
toy being used byanother
Parental report will
suffice.
19 Defends possessions with
determination
Credit ifthe childtries
to hold on towhat is
his when someone
tries to grab this from
him.
20 Plays organizedgroupgames
fairly (e.g., does notcheat in
Parental report will
suffice.
order to win)
21 Can talk about complex
feelings(e.g.,anger, sadness,
worry) he experiences
Parental report will
suffice.
22 Honors a simplebargain with
caregiver (e.g., plays outside
only after cleaning/fixing his
room)
Parental report will
suffice.
23 Watches responsibly over
younger siblings/family
members
Parental report will
suffice.
24 Cooperates withadults and
peers in group situations to
minimize quarrels andconflicts
Parental report will
suffice.
TOTAL SCORE
Transfer the raw score for each domain in the table below. Using the Scaled
Scores Equivalent of Raw Scores Table, convert the raw scores to
Scaled Scores appropriate to the age of the child. To arrive at the Sum of
Scaled Scores, add the Scaled Scores across all domains. To derive the
Standard score, refer to the Standard Scorer Equivalent of Sums of Scaled
Scores Table. Write the Child’s age on each evaluation.

13. SUMMARY OF ASSESSMENT
DOMAIN
Date Assessed: ______________
Child’s Age:________
Date Assessed: ______________
Child’s Age:________
BoSY EoSY
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
RS- Raw Score
SC- Scaled Score

14. BoSY: _______________________________________
INTERPRETATION
EoSY: _______________________________________
INTERPRETATION
Scaled Score Interpretation
1 -3
Suggest significant delay in overall
development
4 - 6
Suggest slight delay in overall
development
7 -13 Average development
14 - 16 Suggest slight advanced in development
17 - 19 Suggest highly advanced in development

15. Summative Assessment Standard Score: ____________________
REMARKS: __________________________
TEACHER: MRS. CONIE A. ABELINDE
SCHOOL HEAD: MRS. VIVERLY L. DE JESUS
Scaled Score Interpretation
69 and below
Suggest significant delay in overall
development
70 - 79
Suggest slight delay in overall
development
80 - 119 Average overall development
120 - 129 Suggest slightly advanced development
130 and above Suggest highly advanced development
Name of examiner: ____________________________
Date administered: ____________________________