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Examiner's Notes: Write Down Your Notes, Descriptions and Observation On The Columns Provided

The document provides a form for examiners to take notes on child assessments. It includes sections to document the child's background, family environment, parents' stimulating activities, home environment, and other notes. Examiners can record details like the child and family's health, economic conditions, types of interaction and activities parents engage in, facilities in the home, and any other relevant information. The form appears to be used to gather a holistic picture of factors that could influence a child's development to inform their assessment.

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Melodie Tabuada
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512 views1 page

Examiner's Notes: Write Down Your Notes, Descriptions and Observation On The Columns Provided

The document provides a form for examiners to take notes on child assessments. It includes sections to document the child's background, family environment, parents' stimulating activities, home environment, and other notes. Examiners can record details like the child and family's health, economic conditions, types of interaction and activities parents engage in, facilities in the home, and any other relevant information. The form appears to be used to gather a holistic picture of factors that could influence a child's development to inform their assessment.

Uploaded by

Melodie Tabuada
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Examiner’s Notes

Write down your notes, descriptions and observation on the columns provided.

Name of examiner :__________________ Name of examiner :__________________ Name of examiner :__________________


Date administered : __________________ Date administered : __________________ Date administered : __________________
Place of test : ______________________ Place of test : ______________________ Place of test : ______________________

Child’s background (ex. Child’s background (ex. Child’s background (ex.


behavior/health/etc.) behavior/health/etc.) behavior/health/etc.)

_______________________________ _______________________________ _______________________________

_______________________________ _______________________________ _______________________________

_______________________________ _______________________________ _______________________________

_______________________________ _______________________________ _______________________________

Family environment (ex. Health of family Family environment (ex. Health of family Family environment (ex. Health of family
members/family problems/ economic members/family problems/ economic members/family problems/ economic
conditions/etc.) conditions/etc.) conditions/etc.)
_______________________________ _______________________________ _______________________________

_______________________________ _______________________________ _______________________________

_______________________________ _______________________________ _______________________________

_______________________________ _______________________________ _______________________________

Parents’ stimulating activities for the child Parents’ stimulating activities for the child Parents’ stimulating activities for the child
(What are the activities/things that the (What are the activities/things that the (What are the activities/things that the
parents do to help stimulate the child’s parents do to help stimulate the child’s parents do to help stimulate the child’s
development?) develop ment?) develop ment?)
_______________________________ _______________________________ _______________________________

_______________________________ _______________________________ _______________________________

_______________________________ _______________________________ _______________________________

_______________________________ _______________________________ _______________________________

Home environment (ex. Facilities/type of Home environment (ex. Facilities/type of Home environment (ex. Facilities/type of
house/ household items/interaction/etc.) house/ household items/interaction/etc.) house/ household items/interaction/etc.)

_______________________________ _______________________________ _______________________________

_______________________________ _______________________________ _______________________________

_______________________________ _______________________________ _______________________________

_______________________________ _______________________________ _______________________________

Others Others Others

_______________________________ _______________________________ _______________________________

_______________________________ _______________________________ _______________________________

_______________________________ _______________________________ _______________________________

Early Childhood Care and Development (ECCD) Checklist, Child’s Record 2 17

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