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    Department of Education: Republic of The Philippines

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    Catherine Renante
    This document appears to be a behavioral evaluation form for a student at Payatas B Elementary School in Quezon City, Philippines. It contains sections to evaluate the student's self-help skills, motor skills, perceptual skills, numerical skills, language development, social/emotional development, and more. The evaluator is asked to rate the student in various areas by checking columns labeled "highly characteristic," "characteristic," "slightly characteristic," or "not characteristic at all." There are also sections for observational remarks.

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    © All Rights Reserved
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    Department of Education: Republic of The Philippines

    Uploaded by

    Catherine Renante
    57 views7 pages
    This document appears to be a behavioral evaluation form for a student at Payatas B Elementary School in Quezon City, Philippines. It contains sections to evaluate the student's self-help skills, motor skills, perceptual skills, numerical skills, language development, social/emotional development, and more. The evaluator is asked to rate the student in various areas by checking columns labeled "highly characteristic," "characteristic," "slightly characteristic," or "not characteristic at all." There are also sections for observational remarks.

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    This document appears to be a behavioral evaluation form for a student at Payatas B Elementary School in Quezon City, Philippines. It contains sections to evaluate the student's self-help skills, motor skills, perceptual skills, numerical skills, language development, social/emotional development, and more. The evaluator is asked to rate the student in various areas by checking columns labeled "highly characteristic," "characteristic," "slightly characteristic," or "not characteristic at all." There are also sections for observational remarks.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    57 views7 pages

    Department of Education: Republic of The Philippines

    Uploaded by

    Catherine Renante
    This document appears to be a behavioral evaluation form for a student at Payatas B Elementary School in Quezon City, Philippines. It contains sections to evaluate the student's self-help skills, motor skills, perceptual skills, numerical skills, language development, social/emotional development, and more. The evaluator is asked to rate the student in various areas by checking columns labeled "highly characteristic," "characteristic," "slightly characteristic," or "not characteristic at all." There are also sections for observational remarks.

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    © All Rights Reserved
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    Republic of the Philippines

    Department of Education
    National Capital Region
    Schools Division Office of Quezon City
    PAYATAS B ELEMENTARY SCHOOL
    ------------------------------------------------------------------------------------------------------------------
    BEHAVIORAL EVALUATION FORM
    S.Y 2020-2021
    GENERAL INFORMATION

    NAME:___________________________________ GRADE: Non-Graded


    HOME ADDRESS:_______________________
    SCHOOL: PAYATAS B ELEMENTARY
    GENDER:________________________________ DIAGNOSIS:__________________________
    DATE OF BIRTH:___________________ RELIGION:_____________________

    MOTHER:________________________ OCCUPATION__________________

    FATHER:_________________________ OCCUPATION:_________________

    A scale for Detecting Intellectual Disability

    Directions: You will be asked to evaluate your child objectively based on your observation and interactions with
    him/her. The child will be rated each item by checking under the column that best describes him/her.

    Legend: BC=highly characteristic of the child

    CC= characteristics of the child

    SC=slightly characteristics of the child

    NC=not characteristics of the child at all

    The child BC CC SC NC
    1 Perform gross-motor adeptly
    2 Performs fine motor tasks(e.g forming puzzles, Assembling lego,
    sringing beads, replicating block arrangements)skillfully
    3 Performs coordinately paper pencil tasks such as tracing, copying and
    drawing
    4 Possesses ample vocabulary
    5 Exhibits clear/articulate speech
    6 Expresses himself/herself adequately/correctly
    7 Comprehends well instructions/lessons presented
    8 Possesses ample attention span
    9 Tackles more difficult and challenging tasks
    10 Writes/composes words/phrases sentences/paragraphs
    11 Possesses keen/retentive memory
    12 Attends independently to his/her personal needs(e.g. eating, dressing,
    grooming)
    13 Makes age-appropriate social adjustments
    14 Performs academically well
    15 Behaves within age level in given situation
    16 Easily gets along/cooperates with others/peers
    17 Makes age-appropriate social judgments/decisions

    Prepared by:

    JOSEFINO D. MINGUILLAN JR.


    Republic of the Philippines
    Department of Education
    National Capital Region
    Schools Division Office of Quezon City
    PAYATAS B ELEMENTARY SCHOOL
    ------------------------------------------------------------------------------------------------------------------

    BEHAVIORAL EVALUATION FORM


    S.Y 2020-2021

    SELF-HELP SKILLS OBSERVATION REMARKS

    FEEDING
    Drinks from a cup/glass
    Drinks with a straw
    Pours liquid from a container
    Use eating utensils like spoon, knife, fork properly
    Serves self from serving plate
    Cleans spillage
    Shows awareness about dirt and mess
    Eats independently
    Cleans and clears place at table
    Know proper table setting
    Consumes all food served
    DRESSING
    Cooperates when dressing/undressing
    Pulls off shoe
    Pulls off sock
    Tie shoes
    Takes off pants, undies
    Takes off dress ,skirt, blouse
    Knows how to zip/unzip
    Knows how to hook/unhook
    Attempts to dress independently
    Attempts to undress independently
    TOILETTING
    Sounds off when wet or soiled
    Uses toilet with help
    Follows complete toiletting, wiping, flushing, washing hand
    Desires independent toiletting
    HYGIENE AND GROOMING
    Washes hands with soap
    Washes face with soap
    Knows how to usea washcloth
    Dries hands/face alone
    Combs/brushes hair properly
    Brushes teeth regularly
    Blows nose on command
    Keeps knows clean with hanky or tissue
    Keeps oneself clean and neat
    Takes care of personal needs
    SAFETY
    Handles sharp objects with care
    Recognizes safety rules
    Practices rules of safety
    MOTOR SKILLS
    GROSS MOTOR DEVELOPMENT
    Jumps over an object with both feet
    Walks forward independently
    Climbs upstairs and goes downstairs using alternate feet
    Skips well with or without rope
    Balances well with within a given path
    Hops well
    Handles balls and blocks with ease
    Kicks while standing
    FINE MOTOR DEVELOPMENT
    Builds tower at 2nd stage of block building
    String beads on the thread of shoelace

    Republic of the Philippines


    Department of Education
    National Capital Region
    Schools Division Office of Quezon City
    PAYATAS B ELEMENTARY SCHOOL
    ------------------------------------------------------------------------------------------------------------------

    BEHAVIORAL EVALUATION FORM


    S.Y 2020-2021

    OBSERVATION REMARKS

    Performs twisting activities efficiently


    Folds paper or napkins efficiently
    Folds paper or napkin with ease
    Cut straight lines
    Cut jagged lines
    Cuts a round picture
    Rolls up mats, paper or any item with similar materials
    Tears paper with lines
    Rolls balls
    Holds pencils, crayons and paint brush properly
    Uses 3 finger grasp
    Puts small objects in a bottle
    Handle pegs on board properly
    PERCEPTUAL SKILLS
    CLASSIFICATION:
    Compares objects according to
    Size
    Height
    Color
    Texture
    Quantity (more or less)
    Taste
    SERIATION
    Orders by size
    Orders by length
    Orders by texture
    Orders by color
    Orders by quantity
    RECOGNITION
    Identifies shapes
    Identifies or recognizes Philippine money
    Recognizes prominent color
    Identifies missing part or puzzle
    Recognizes distinct sounds or tunes simple
    Recognizes simple pictures of objects or creatures
    Finds out opposites up-down
    Finds out opposites sad-happy
    SPATIAL RELATIONS
    Understands distinctions of in-out
    Understands distinctions of under-above
    Understands distinctions of front -back
    Understands distinction of up-down
    Understand distinction of left-right
    Understand distinction beside-between
    NUMERICAL SKILLS
    Repeats numbers out of sequence
    Put objects in containers (1-10)
    Counts or points to 3 objects
    Counts or points to 6 objects
    Counts 5 objects aloud without assistance
    Counts 8 objects aloud without assistance
    Counts 10 objects aloud without assistance
    Counts and tell how many
    Count beyond 10
    Adds combinations totaling up to 10
    Subtract combinations resulting to differences with the 1-10
    range
    Names positions of objects from a set
    Republic of the Philippines
    Department of Education
    National Capital Region
    Schools Division Office of Quezon City
    PAYATAS B ELEMENTARY SCHOOL
    ------------------------------------------------------------------------------------------------------------------

    BEHAVIORAL EVALUATION FORM


    S.Y 2020-2021

    OBSERVATION REMARKS

    Tells distinction between more and less


    Sequence symbols
    Matches equal set 1-10 objects
    Points to names numerals (1-25)
    LANGUAGE DEVELOPMENT
    LISTENING, SPEAKING AND REASONING SKILLS
    Expresses thoughts or ideas clearly
    Follows oral direction with accuracy
    Tells story about a picture spontaneously
    Recites rhymes, sort poems with proper expression
    Speaks distinctly
    Listens to orally read stories or poems
    Sequences parts of the story as required
    Imitates actions that go together with songs and rhymes
    Deduces insights related to values from stories
    Shows ability to alter parts of stories, poems or songs
    Uses vocabulary normal for the age level
    Speaks in proper sentence structures
    READING SKILLS
    Knows sound of alphabet
    Recognizes his name in print
    Discriminates- beginning
    Discriminates-middle
    Discriminates-ending
    Discriminates phonetic sounds
    Read simple c-v-c patterns words
    WRITING SKILLS
    Executes fundamental strokes
    Writes letter legibly following the lines
    Writes names accurately
    Copies simple words correctly
    Grips pencil properly while writing
    Colors evenly following lines
    Shows mastery of letter forms
    MEMORY RECALL
    Recalls 4 objects seen in a picture
    Tells what is missing when one object is removed from a group of
    3
    Retells 5 main factors from the story heard 3 times
    Retells sequences of a story
    Names days of the week in order
    Identifies objects, persons, events in stories with accuracy
    Repeats back rhythm made by the teacher
    SOCIAL AND EMOTIONAL DEVELOPMENT
    Relates well with others in work
    Plays at ease with others
    Shares with others
    Responds positively to the authority
    Exhibits self confidence
    Welcomes responsibilities
    Shows a happy disposition
    Copes well with varying situations
    Initiates interaction
    Responds to his name when called
    Stops crying with verbal attention

    Republic of the Philippines


    Department of Education
    National Capital Region
    Schools Division Office of Quezon City
    PAYATAS B ELEMENTARY SCHOOL
    ------------------------------------------------------------------------------------------------------------------

    BEHAVIORAL EVALUATION FORM


    S.Y 2020-2021

    OBSERVATION REMARKS

    Shows affection to adults


    Seeks comfort through physical contact
    Interactions with stranger
    Explores environment
    Plays appropriate in one rule game
    Identifies personal belongings
    Cares for his personal belongings
    Accepts routines and adjust to changes
    Knows how to listen
    Knows how to follow adult direction
    Greets visitors and other familiar personalities
    Behaves appropriately
    Know how to say,” please”,”excuse me”, “thank you,” “po at
    opo”
    CREATIVE ARTS
    Expresses ideas through drawings or other art works
    Sings at ease
    Draws simple object representations
    Participate actively in dramatic o plays
    Uses modeling dough efficiently
    Creates own style of objects
    WORK HABITS
    Work neatly
    Completes work on time
    Handles with care instructions with accuracy
    Initiates clean-up of things which were meshed up
    Packs up materials which were used
    CHRISTIAN VALUES AND ATTITUDES
    Shows awareness of God
    Listens attentively to bible
    Recites simple memory verse
    Knows Christian songs
    Knows how to pray
    Understand basic biblical concepts
    Practices biblical values such as love, obedience, kindness etc
    Desires to attend Sunday Church Activities

    Legend:

    Present

    Not Present

    Fairly Observed

    Prepared by:

    JOSEFINO D. MINGUILLAN JR

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