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

Child’s Handedness (Check appropriate right left

Box)
both 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):

Early Childhood Care and Development (ECCD) Checklist, Child’s Record 1 1

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.
Assessment
No. Year Month Day Examiner’s Name

0-4
Date Tested
Child’s Date of Birth
months Child’s Age

5-8 Date Tested

Child’s Date of Birth
months Child’s Age

9-
Date Tested
Child’s Date of Birth

12 Child’s Age
Date Tested
13- Child’s Date of Birth
mont
18
Child’s Age
hs
19-
Date Tested
Child’s Date of Birth
mont
24
Child’s Age
hs
25-
Date Tested
Child’s Date of Birth

36
Child’s Age

Introducing the Checklist

Introduce the Checklist to the parent/caregiver by saying 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.

After rapport has been established, introduce the Checklist to the child aged 1.0 year or older by
saying 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.

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 How to Administer

This form can be used for six separate evaluations of the same child so it
will be easy for you to see how he is developing as he grows older. The
“Present” portion of this 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.

Where to start and stop

For infants aged 0 month to 1.0 year:

The first few items 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 have been marked with a
hyphen (-).

For children aged 1 year 1 month to 3.0 years:

You may start 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 you observe 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.

How to 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

Early Childhood Care and Development (ECCD) Checklist, Child’s Record 3

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 that section. They are to be counted when you add up the
scores for each domain.

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

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 Gross Motor Domain
A. Infants Section (Ages 0 month - 1.0 year)

Gross Motor Material/Procedure Present Comments

1st 2n 3rd 4th 5th 6th
1. Infant lifts PROCEDURE: d
head when Hold the child in an upright
held standing 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.

2. Infant tries to PROCEDURE:

lift head when Place the child on his
lying on stomach on a flat surface.
stomach 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 PROCEDURE:
head upright Place the child on his
on his own stomach on a flat surface.
when lying Credit if the child lifts his
on stomach head and chest up so that
his face makes a 90° angle
w/ the surface for at least
several seconds. Parental
report will suffice.
4. Infant holds Parental report will suffice.
head
steadily

5. Infant rolls over PROCEDURE:

from his back to Place the child on his back on a
his stomach flat surface. Encourage him to
with assistance roll over to his stomach,
providing some assistance to
do so. Credit if he eventually
rolls over. Parental report will
suffice.
6. Infant turns from PROCEDURE:
his side to his Roll the child from his back
back without to his side. Make sure he is not
assistance restricted by 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.
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7. Infant sits well PROCEDURE:
with support, Hold the child in a sitting
leaning on hands position on the table and slowly
if placed on remove your hand from the child
hard surface 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.

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 Gross Motor Material/Procedure Present Comments
1st 2nd 3r 4th 5th 6th
8. Infant Parental report will suffice. d
bounces when
held standing,
briefly
bearing
weight on
legs
9. Infant sits alone PROCEDURE:
steadily 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. Parental report
will suffice.
10 Infant moves MATERIAL: any toy
. from sitting to PROCEDURE:
creeping/ Seat the child on the floor.
crawling Place a toy on the floor, in
position front of the child, but not
within his reach. Observe
how the child moves from
sitting to creeping position and
the type of movement he
makes to reach for the toy.
Credit if the child moves
forward about 9 inches or
more, using either of the
following: hands and
knees, stomach and arms,
hands and feet. Parental
report will suffice.
11 Infant pulls PROCEDURE:
. self from With the child in a sitting
sitting to position, hold both his hands
standing and have him pull himself up
position with with only minimal assistance
minimal from the adult. Credit if the
assistance child can stand up. Parental
report will suffice.

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12 Stands with MATERIAL: elevated piece of
. minimum furniture PROCEDURE:
support Credit if the child holds on to
a piece of furniture with both
hands and bears weight on both
feet. Parental report will suffice.

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B. Optional starting point for children aged 1 year 1 month - 3.0 years
Gross Motor Material/Procedure Present Comments
1st 2n 3r 4th 5th 6th
13 Holds furniture MATERIAL: toy d d
. with both hands PROCEDURE:
and walks While the child is standing,
sideways observe if he moves from one
point to another by walking
sideways. He may support
himself by holding on to
furniture. He can be
encouraged to walk by
placing a toy on the
furniture near the child but
just outside his reach 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 Walks with PROCEDURE:

. both hands Observe the child if he walks
held when both hands are held by
an adult. Credit if the child
takes coordinated walking
steps with only slight
support from the adult.
Parental report will suffice.
15 Climbs on Parental report will suffice.
. chair or
another
elevated
piece of
furniture
like a bed
without help
16 Walks alone, PROCEDURE:
. rarely falls Observe the child if he walks
alone across the room.
Credit if the child walks
alone with good balance
without tripping and
rarely falling. Parental
report will suffice.
17 Walks backwards PROCEDURE:
. Ask the child to walk
backwards by
demonstrating it. Credit if
the child is able to walk
backwards without falling
and holding on to anything.
Parental report will suffice.

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18 Runs MATERIAL: ball
. without PROCEDURE:
tripping or Encourage the child to run by
falling rolling a ball across the
floor. Credit if the child can
run fast and smoothly
without tripping or falling.
19 Walks down Parental report will suffice.
. stairs, 2 feet
on each step,
with one hand
held
Gross Motor Material/Procedure Present Comments
1st 2n 3r 4th 5th 6th
d d
20 Walks up MATERIAL: toy
. stairs holding PROCEDURE:
handrail, 2 Place a toy in the middle of
feet on each the step and ask the child to
step 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.
Parental report will suffice.
21 Walks upstairs MATERIAL: toy
. with alternate PROCEDURE:
feet without Place a toy in the middle of
holding on to the step and ask the child to
the handrail walk upstairs to get the toy.
Credit if the child walks
upstairs, alternating his
feet as he steps on each
successive step without
holding on to the
handrail or wall for
support.
Parental report will suffice.

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22 Walks MATERIAL: toy
. downstairs PROCEDURE:
with alternate Place a toy at the bottom of the
feet without stairs and ask the child to walk
holding onto downstairs to get the toy.
a handrail Credit if the child walks
downstairs, alternating his
feet as he steps on each
successive step without
holding on to the
handrail or wall for
support. Do not give
credit if the child places
both feet on the step or
uses the handrail or wall
for support.
Parental report will suffice.

TOTAL SCORE

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 Fine Motor Domain
A. Infants Section (Ages 0 month -
1.0 year)
Fine Motor Material/Procedure Present Comments
1st 2nd 3rd 4th 5th 6th
1. PROCEDURE:
Hands of
Observe the infant’s hands.
infant are
Credit if his hands are open
kept open
most of the time.
most of the Parental report will suffice.
time
2. MATERIAL: dangling
Infant waves object/toy This must be
arms, moves elicited by the interviewer.
body at the PROCEDURE: Dangle the toy in
sight of a front of the child
dangling
object/toy
Infant brings
3. MATERIAL: dangling
both hands object/toy This must be
together elicited by the interviewer.
toward
dangling
object/toy
4.
Infant reaches MATERIALS: small toy/spoon
for and holds PROCEDURE:
small toy/ spoon Hold a small toy/spoon in your
hand and urge the infant to
get it.
This must be elicited by the
interviewer.

B. Optional starting point for children aged 1year 1 month - 3.0 years
Fine Motor Material/Procedure Present Comments
1st 2n 3r 4th 5th 6th
5. Uses all five MATERIAL: any small toy /object d d
fingers to get PROCEDURE:
food/toys placed Seat the child on the parent’s
on flat surface lap with his elbows at level
with the tabletop and his
hands on the table or flat
surface. Drop a small toy in
front of him and attract his
attention by pointing to the toy
or tapping the table/flat
surface. Credit if the child
picks up the toy, using all
five fingers as if raking.

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6. Picks up objects MATERIAL: any small toy or
with thumb and food PROCEDURE:
index finger Place a toy/food in front of the
child and within his reach.
Attract his attention 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. Pulls toy with MATERIAL: toy with string
string This must be elicited by the
interviewer.
Fine Motor Material/Procedure Present Comments
1st 2nd 3r 4th 5th 6th
8. Displays a MATERIAL: toy d
definite hand PROCEDURE:
preference Place the toy directly in front of
the child at midline (not to his
left or his right) and ask him
to reach for this. Credit if he
uses the same hand two
out of three times. Parental
report will suffice.
9. Grasps and MATERIALS: 2 small
transfers toys PROCEDURE:
objects from Observe if the child transfers a
hand to hand small toy from one hand to the
other. Encourage this by giving
the child a toy and then
present- ing another toy to the
same hand. Credit if the child
transfers a toy from one
hand to the other without
using his mouth or body.
10 Pushes or pulls MATERIAL: Interviewer’s kit or
. a large object some large object
PROCEDURE:
Demonstrate pushing or pulling
a large object.
This must be elicited by the
inter- viewer.
11 Puts small MATERIALS: small objects and
. objects in/out of container This must be elicited by
container the interviewer.

12 Holds crayon MATERIAL: crayon

. with all the PROCEDURE:
fingers of his Present child with a crayon and
hand making have him get this. Credit if he
a fist (i.e., holds it by wrapping all five
palmar grasp) fingers around as if making a
fist. Automatically Credit this
item if he uses the tips of all five
fingers or the tips of his
thumb, index, and middle
fingers.
Early Childhood Care and Development (ECCD) Checklist, Child’s Record 13
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 This must be elicited by the
interviewer.
13 Unscrews lid of MATERIALS: Container with
. container or screw-on top or wrapped
unwraps food candy.
This must be elicited by the
interviewer.
14 Scribbles MATERIALS: paper, pencil/crayon
. spontaneously PROCEDURE:
Place a paper and
pencil/crayon on the table and
ask the child to draw anything
he wants without showing him
what 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

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 Self-Help Domain
A. Infants Section (Ages 0 month -
1.0 year)
Self-Help Material/Procedure Present Comments
1st 2n 3r 4th 5th 6th
1. Infant sucks Parental report will suffice. d d
and swallows
milk from breast
or bottle

2. Infant begins to Ask the caregiver if the

take solid foods child can take semi-solid or
mashed foods. Credit if the
caregiver reports that the
child tolerates these.
Write “No opportunity” in
the comment section if
the child has not been
introduced to solid foods.
3. Chews solid Parental report will suffice.
food well

B. Optional starting point for children aged 1 year 1 month - 3.0 years
Self-Help Material/Procedure Present Comments
1st 2n 3r 4th 5th 6th
d d
4. Holds bottle all Parental report will suffice.
by himself

5. Feeds self MATERIALS: bread,

with finger biscuits This must be
food (e.g., elicited by the interviewer.
biscuits,
bread)
using
fingers
6. Helps hold a Note: The cup should not
cup for have a lid or spout.
drinking
7. Feeds self Parental report will suffice.
using fingers to
eat rice/ viands
with spillage
8. Drinks from a cup MATERIALS: drinking cup,
without help water This must be elicited
by the interviewer.

9. Feeds self Parental report will suffice.

using a spoon
with spillage

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10 Gets a drink for Parental report will suffice.
. himself without
any help

TOTAL SCORE

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 Receptive Language Domain
A. Infants Section (Ages 0 month - 1.0 year)

Receptive Language Material/Procedure Present Comments

1st 2n 3r 4th 5th 6th
1. Infant startles Parental report will suffice. d d
to loud
sounds
2. Infant turns MATERIAL: rattle
eyes/ head PROCEDURE:
toward sound Carry the child on his back
with one hand and with the
other shake a rattle out of his
range of vision 6 inches from
his ear. Do this continuously
for 3 seconds and observe
whether he can turn towards
the sound. Credit if the
child widens or moves his
eyes from side to side in
search of the sound.
3. Infant Parental report will suffice.
watches
mother
intently as she
speaks to him
4. Infant Parental report will suffice.
smiles at a
familiar
voice, like
when his
mother talks
to him.
5. Infant stops Parental report will suffice.
crying when
sung to
6. Turns head PROCEDURE: Go behind the
when called by child a few feet away and call out
name, makes his name. Observe if the child
eye contact can look for you and smile.
Parental report will suffice.
7. Understands “no” PROCEDURE: Shake your head
and finger and say “No-no”.
Then see whether the child
understands this. Credit if
the child stops what he is
doing. Parental report will
suffice.
8. Imitates PROCEDURE: Place the child
adults’ playful on the caregiver’s lap with
sounds like you facing the child. Then
coughing, lip make the following sounds:
smacking cough, smack lips. Credit if
the child makes the same
sound or even just the lip
movements.
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9. Follows one MATERIAL: spoon or any object
step- command PROCEDURE:
(e.g. give) when With the child seated in front of
gestures are you, give him a spoon then ask
used for the spoon back by saying
“GIVE ME THE _(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 does not
release this immediately.

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 Receptive Language Material/Procedure Present Comments
1st 2n 3r 4th 5th 6th
d d
10 Follows one MATERIAL: toy
. step- command PROCEDURE:
without need Place the toy on the floor
for gestures and ask the child to pick this
up without pointing to the toy
or using any other gesture.
Credit if the child picks up
the toy.
11 Points to a family PROCEDURE:
. member when Ask the child to point to his
asked to do so mother/ caregiver. Credit if
he does so.

B. Optional starting point for children aged 1year 1 month - 3.0

yea
rsReceptive Language Material/Procedure Present Comments
1st 2nd 3r 4th 5th 6th
12 PROCEDURE: d
Points to five
. body parts Have the child point to his
on himself eyes, nose, mouth, hands
when asked and feet. Credit if he can
to do so point to all these.
13 Points to five MATERIAL: picture book 1
. named PROCEDURE:
pictured Show the child a picture book
objects when (two pictures per page) and ask
asked to do so him to point to the picture by
saying “Where’s the
?” Credit if the
child can use his finger
to point to at least five
pictures.
14 Follows one- MATERIAL: block/toy
. step PROCEDURE:
instructions Ask the child to put a block/toy
that include under the table; on the table; in
simple the bag. Do not point or use
prepositions gestures when giving the
(e.g., in, on, instruction. Credit if the
under, etc.) child is able to follow at
least one of the
instructions.

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15 Follows two-step MATERIAL: block/toy
. instructions that PROCEDURE:
include simple Ask the child to get a
prepositions block/toy from under the
table and then place it on
the table. Do not point or use
gestures when giving the
instruction. Credit if the
child is able to follow.

TOTAL SCORE

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 Expressive Language Domain
A. Infants Section (Ages 0 month - 1.0 year)
Expressive Language Material/Procedure Present Comments
1st 2nd 3r 4th 5th 6th
1. Infant vocalizes Parental report will suffice. d
(e.g., gurgles,
coos, grunts)

2. Infant vocalizes to Parental report will suffice.

express pleasure
or displeasure

3. Infant shouts to Parental report will suffice.

attract the
attention of the
caregiver
4. Infant laughs out Parental report will suffice.
loud and squeals

5. Infant vocalizes Parental report will suffice.

different vowel
sounds (e.g., ahh,
oooh)
6. Infant vocalizes PROCEDURE:
other sounds that Ask caregiver if the child
do not mean can make two different
anything sounds apart from
crying like “goo”and
“er”. Take note of the
sounds. Parental report will
suffice.
7. Infant babbles Parental report will suffice.
continuously to
amuse self or
attract attention
8. Infant tries to Parental report will suffice.
imitate the
caregiver’s
vocalizations
9. Infant uses body Parental report will suffice.
movements/gestur
es to make wants
known (e.g.,
stretches arms to
indicate
what he wants)

B. Optional starting point for children aged 1 year 1month - 3.0 years
Expressive Language Material/Procedure Present Comments
10 Repeats vowel- Parental report will suffice.
. consonant
combinations
without
referring to
anything or

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 anyone (e.g.,
baba, mama,
dada)

11 Uses sounds Parental report will suffice.

. meaningfully to
refer to specific
objects/persons
(e.g. “Mama” for
his mother;
“mamam” for
. water)
Expressive Language Material/Procedure Present Comments
12 1st 2nd 3r 4th 5th 6t
Chatters in a d h
. conversational Parental report will suffice.
tone without using
real words.

13 Tries to Parental report will suffice.

. imitate real
words of
adult

14 Combines single Parental report will suffice.

. words and
gestures to make
wants known (e.g.,
“out” while
pointing to the
door)
15 Uses 5 to 20 PROCEDURE: Ask the
. recognizable words 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 Parental report will suffice.
. (e.g. I, me, ako,
akin)
17 Uses two- to Parental report will suffice.
. three-word verb-
noun combinations
(e.g., hingi
gatas)
18 Names objects MATERIAL: picture book
. in pictures PROCEDURE: Show the
child a picture book, point
to an object in the book,
then ask him to name this
(e.g., Ano ito?). Credit
if the child can say the
correct name of at
least four objects.
Parental report will suffice.
19 Speaks in Parental report will suffice.
22 Early Childhood Care and Development (ECCD) Checklist, Child’s Record
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. grammatically
correct two- to
three- word
sentences
20 Asks “what” questions Parental report will suffice.
.
21 Asks “who” and Parental report will suffice.
. “why “ questions

22 Gives account of PROCEDURE:

. recent Ask the caregiver if the
experiences child can recount recent
(with experiences in correct
prompting) in sequence and using past
order of tenses correctly. The
occurrence caregiver can prompt him
using past so he can complete what
tense he is talking about (e.g.,
Tapos ano pang
nangyari?). Parental report
will
suffice.
TOTAL SCORE

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 Cognitive Domain
A. Infants Section (Ages 0 month -
1.0 year)

Cognitive Material/Procedure Present Comments

1st 2n 3r 4th 5th 6th
1. Infant inspects Credit if the infant d d
surroundings looks around the
room.

2. Infant gazes Parental report will suffice.

slowly at moving
objects/ people

3. Infant turns Parental report will suffice.

head to bright
colored
objects

4. Infant changes Parental report will suffice.

face when he
does not like
the taste of
his food
5. Infant explores MATERIAL: clean
and toy/object
manipulates PROCEDURE:
objects by Give the child a clean toy or
biting, object and observe if he brings
holding, and it to his mouth to bite or chew.
looking at them

6. Infant shakes MATERIAL: rattle

toy deliberately PROCEDURE:
to make this Give the child a rattle and
sound observe if he 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 eventually PROCEDURE:
gets used to Ask the caregiver if the child
irritating or eventually gets used to
bothersome environmental sounds like that
environmental of a tricycle/other vehicles, sound
sounds (e.g., of animals (chicken, dogs)
tricycle, that may have woken,
crowing of bothered or irritated him
cock) earlier. Parental report will
suffice.

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8. Infant reacts to MATERIAL: cloth
cloth placed over (handkerchief or face towel)
his face PROCEDURE:
With the child lying on his
back, gently cover his face with
a paper/cloth and observe if he
tries to remove this or pull it away.

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B. Optional starting point for children aged 1 year 1 month - 3.0 years

Cognitive Material/Procedure Present Comments

1st 2n 3r 4th 5th 6th
9. Looks in the MATERIAL: spoon/ball d d
direction of a PROCEDURE:
fallen object With the child seated, get his
attention and drop a spoon/ball
in front of him. Then observe if
his eyes look down as the object
falls. Credit if the child can
bring his eyes and head
down as the object falls.
10 Displays a Parental report will suffice.
. preference for
certain objects
by reaching
for these
more readily
than others
11 Pushes the MATERIAL: ball
. ball to make This must be elicited by the
it roll interviewer.

12 Repeatedly drops MATERIAL: toy

. or throws PROCEDURE:
objects While carrying the child, hand
him the toy and see if he drops
or throws this as if fascinated
with the act of doing so.
Parental report will suffice.
13 Looks for a MATERIALS: ball, small towel/cloth
. partially hidden PROCEDURE:
object With the child facing you,
partially hide a ball behind a
small towel and observe if he
will look for it and find it.
Credit if the child pulls the
towel and gets the hidden
ball.

14 Imitates Parental report will suffice.

. behavior seen
just a few
minutes
earlier
15 Offers object Parental report will suffice.
. but will not
release it

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

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16 Looks for MATERIALS: ball, small towel/cloth
. completely PROCEDURE:
hidden object With the child facing you,
hide a ball completely under a
small towel and observe if he
will look under the towel.
Credit if he looks under the
towel and gets the hidden
ball.

Early Childhood Care and Development (ECCD) Checklist, Child’s Record 27

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B. Optional starting point for children aged 1 year 1 month - 3.0 years

Cognitive Material/Procedure Present Comments

1st 2nd 3r 4th 5th 6th
17 Exhibits MATERIALS: doll or toy car/block d
. simple PROCEDURE:
pretend play If the child is a girl, carry the
(feeds, puts doll and try to rock it to sleep. If
doll to sleep) the child is a boy, move the toy
car/block back and forth.
Credit if the child can
imitate this.
18 Matches objects MATERIALS: pairs of spoons,
. balls, blocks PROCEDURE:
Place one spoon, one ball, and
one block on the table. Give the
child the other set of objects
arranged in random order.
Demonstrate a matching
response (e.g., spoon to
spoon) then return the objects
to the child. Say, “Put each
object on the one that is just
like it.” Credit if the child
can match the objects
correctly.

TOTAL SCORE

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 Social-Emotional Domain
A. Infants Section (Age 0 months - 1.0 years)
Social-Emotional Material/Procedure Present Comments
1st 2n 3r 4th 5th 6th
1. Infant stops Parental report will suffice. d d
crying when
mother picks
him
2. Infant Parental report will suffice.
smiles in
response to
the
caregiver
3. Infant reacts Parental report will suffice.
to familiar
situations like
bathing or
feeding (e.g.,
thrashes about,
sucks vigorously
at the sight of
bottle)
4. Infant lifts arms Parental report will suffice.
to greet familiar
people

B. Optional starting point for children aged 1 year and 1 month to 3.0 years
Social-Emotional Material/Procedure Present Comments
1st 2n 3r 4th 5th 6th
d d
5. Cries when Parental report will suffice.
caregiver leaves

6. Enjoys Parental report will suffice.

watching
activities of
nearby people
or animals
7. Smiles playfully MATERIAL:
at mirror image mirror
PROCEDURE:
With the child in a sitting
position, place a mirror in
front of him and observe if he
stares at or tries to get the
mirror 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. Friendly with Parental report will suffice.
strangers but
initially may
show slight

Early Childhood Care and Development (ECCD) Checklist, Child’s Record 29

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 anxiety or
shyness
9. Plays alone but Parental report will suffice.
likes to be near
familiar adults
or brothers
and sisters
10. Laughs or Parental report will suffice.
squeals
aloud in
play

Social-Emotional Material/Procedure Present Comments

1st 2n 3r 4th 5th 6th
d d
11 Plays peek-a-boo Parental report will suffice.
. (bulaga)

12. Rolls ball Parental report will suffice.

interactively
with
caregiver/examin
er
13. Hugs or cuddles Parental report will suffice.
toys
14. Responds with Parental report will suffice.
pleasure to
friendly people

TOTAL SCORE

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

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Name of examiner :
Date administered :
Place where test is administered :

To the examiner :
Please fill out the spaces below for additional information.
Thank you very much. Write down your notes, descriptions and
observations on the following points:

Child’s background (ex. behavior/health/etc.)

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

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

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

Others

Early Childhood Care and Development (ECCD) Checklist, Child’s Record 31

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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. To arrive at the Sum of Scaled Scores, add the Scaled Scores across all
domains. To derive the Standard Score, refer to the Standard Score Equivalent of Sums of
Scaled Scores Table. Write the child’s age on each evaluation.

Age
Domain 1 Evaluation
st

Child’s Age
Date: 2 Evaluation
nd

Child’s Age
Date: 3rd Evaluation

Child’s Age
Date:

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

Age
Domain th
4 Evaluation

Child’s Age
Date: 5 Evaluation
th

Child’s Age
Date: 6th Evaluation

Child’s Age
Date:

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

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

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 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

EXPRESSIVE LANGUAGE

EXPRESSIVE LANGUAGE
EXPRESSIVE LANGUAGE
RECEPTIVE LANGUAGE

RECEPTIVE LANGUAGE
RECEPTIVE LANGUAGE
SOCIAL-EMOTIONAL

SOCIAL-EMOTIONAL
SCALED SCORE

SOCIAL-EMOTIONAL

SCALED SCORE
SCALED SCORE
GROSS MOTOR

GROSS MOTOR
GROSS MOTOR
FINE MOTOR

FINE MOTOR
FINE MOTOR
COGNITIVE

COGNITIVE
COGNITIVE
SELF-HELP

SELF-HELP
SELF-HELP
19 • • • • • • • 19 • • • • • • • 19 • • • • • • •

18 • • • • • • • 18 • • • • • • • 18 • • • • • • •

17 • • • • • • • 17 • • • • • • • 17 • • • • • • •
Suggests advanced

16 • • • • • • • 16 • • • • • • • 16 • • • • • • •
development

15 • • • • • • • 15 • • • • • • • 15 • • • • • • •

14 • • • • • • • 14 • • • • • • • 14 • • • • • • •
13 • • • • • • • 13 • • • • • • • 13 • • • • • • •

12 • • • • • • • 12 • • • • • • • 12 • • • • • • •
Average development

11 • • • • • • • 11 • • • • • • • 11 • • • • • • •

10 • • • • • • • 10 • • • • • • • 10 • • • • • • •

9 • • • • • • • 9 • • • • • • • 9 • • • • • • •

8 • • • • • • • 8 • • • • • • • 8 • • • • • • •

7 • • • • • • • 7 • • • • • • • 7 • • • • • • •

6 • • • • • • • 6 • • • • • • • 6 • • • • • • •
Re-test after 3- 6 months

5 • • • • • • • 5 • • • • • • • 5 • • • • • • •

4 • • • • • • • 4 • • • • • • • 4 • • • • • • •

3 • • • • • • • 3 • • • • • • • 3 • • • • • • •

2 • • • • • • • 2 • • • • • • • 2 • • • • • • •

1 • • • • • • • 1 • • • • • • • 1 • • • • • • •

Early Childhood Care and Development (ECCD) Checklist, Child’s Record 33

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 Child’s Age: Child’s Age: Child’s Age:
DOMAIN DOMAIN DOMAIN

EXPRESSIVE LANGUAGE

EXPRESSIVE LANGUAGE
EXPRESSIVE LANGUAGE
RECEPTIVE LANGUAGE

RECEPTIVE LANGUAGE
RECEPTIVE LANGUAGE
SOCIAL-EMOTIONAL

SOCIAL-EMOTIONAL
SCALED SCORE

SOCIAL-EMOTIONAL

SCALED SCORE
SCALED SCORE
GROSS MOTOR

GROSS MOTOR
GROSS MOTOR
FINE MOTOR

FINE MOTOR
FINE MOTOR
COGNITIVE

COGNITIVE
COGNITIVE
SELF-HELP

SELF-HELP
SELF-HELP
19 • • • • • • • 19 • • • • • • • 19 • • • • • • •

18 • • • • • • • 18 • • • • • • • 18 • • • • • • •

17 • • • • • • • 17 • • • • • • • 17 • • • • • • •
uggests advanced

16 • • • • • • • 16 • • • • • • • 16 • • • • • • •
development

15 • • • • • • • 15 • • • • • • • 15 • • • • • • •

14 • • • • • • • 14 • • • • • • • 14 • • • • • • •

13 • • • • • • • 13 • • • • • • • 13 • • • • • • •
Average developmentS

12 • • • • • • • 12 • • • • • • • 12 • • • • • • •

11 • • • • • • • 11 • • • • • • • 11 • • • • • • •

10 • • • • • • • 10 • • • • • • • 10 • • • • • • •

9 • • • • • • • 9 • • • • • • • 9 • • • • • • •

8 • • • • • • • 8 • • • • • • • 8 • • • • • • •

7 • • • • • • • 7 • • • • • • • 7 • • • • • • •

6 • • • • • • • 6 • • • • • • • 6 • • • • • • •
Re-test after 3- 6 months

5 • • • • • • • 5 • • • • • • • 5 • • • • • • •

4 • • • • • • • 4 • • • • • • • 4 • • • • • • •

3 • • • • • • • 3 • • • • • • • 3 • • • • • • •

2 • • • • • • • 2 • • • • • • • 2 • • • • • • •

1 • • • • • • • 1 • • • • • • • 1 • • • • • • •

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

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First Printing

NOT FOR SALE

January 2004
Manila, Philippines

Standard Scores
Mark an x on the corresponding Standard Score for each test administration and connect the x’s. Write the date
for each test administration.

AGE

160 0-4 5-8 9-12 13-18 19-24 25-36 months

months months months months months
Suggests advanced

150
development

140

130

120
Average development

110

100

90

80

70
Re-test after 3 to 6 months

60

50

40

30

20

Early Childhood Care and Development (ECCD) Checklist, Child’s Record 35

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Date Tested

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

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