II. Educational Assessment A. Assessment Tools

Republic of the Philippines
Department of Education
Region XI
Schools Division of Davao City
BANGOY DISTRICT
VICENTE HIZON SR., ELEMENTARY SCHOOL
Name: ______________________________________ Grade/ Level: ________________ LRN #:_______________

Teacher: ___________________________ School: _______________________________ Date: ________________
Name of Parents/Guardians: __________________________ Address: ______________________________________
Birthdate: ____________________________________ Age: ______________School ID : _____________________
INFORMAL ASSESSMENT CHECKLIST IN DIFFICULTY APPLYING KNOWLEDGE
Instruction: Put the check (/) mark if it is YES if observed or NO if not observed.
YES NO
CHARACTERISTICS (If (If not INTERVENTION REMARKS
observed) observed)
Difficulty learning connections
between letters and sounds
Confused in short words (at and to)
Letter reversals
Word reversals
Frequently adds and/or forgets letters
in a word
Difficulty in remembering simple
sequences
Difficulty keeping in place when
reading
Poor sequencing of numbers
Poor spelling
Avoids reading aloud
Difficulty organizing ideas to speak or
write
Avoids writing tasks
Left and Right confusion
Slow to memorize tasks and math
Trouble following oral instructions
Appearing restless or easily distracted
Difficulty in reading
Difficulty in writing
Difficulty in spelling
Difficulty in counting and calculating
Assessed by: Date:
________________________________ ______________

Region XI
BANGOY DISTRICT

INFORMAL LEARNING DIFFICULTIES CHECKLIST IN VISUAL IMPAIRMENT

YES (Y) NO (N)
CHARACTERISTICS (being (not INTERVENTION REMARKS
observed) observed)
eyes move quickly from side to side
(nystagmus), jerk or wander
randomly
Don’t follow your face or an object
Don’t seem to make eye contact with
family and friends
Eyes don’t react to bright light being
turned on in the room
Display repetitive, stereotyped
movement like rocking or rubbing of
eyes
Withdrawn, dependent and unable to
use non-verbal cues
Unusual facial behaviors such as
squinting, blinking, or frowning
while reading
Unable to locate or pick up small
objects
Poor eye-hand coordination
Problems in distinguishing similar
shaped letters, numbers or words for
ex. B and D
limited attention span in reading or
writing activities
makes excessive head movements or
tilts when looking at print or reading
reluctant to commence reading,
writing or close work
makes errors when copying, missing
letters, words, lines
squints or frowns when looking at
things-near or far
has problems tracking print-losses
place reading, skips lines
holds book very closely
omits words or makes errors when
reading or copying
closes or covers one eye when
reading or doing near work
confuses similar words
has unusual sitting posture when
reading
tilts head excessively to one side, up
or down
holds head forward to look at a
distance
rubs or pokes eyes
turns head to apparently favor one
eye
is nervous, irritable, tense, or restless
after maintaining visual
concentration is slow
misses some nonverbal clues
misinterprets social clues
turned eyes/eyes-in or out

frequent eye movements, quivering
frequent blinking
red eyes
frequent eye infection
watering eyes
light sensitivity
headache
Sore eyes
feeling of pressure in, near, behind
eyes
difficulty seeing clearly at distance
blurring of vision while reading or
writing
print moves while reading and
writing
seeing double
burning or itching eyes especially
during or after close work
Screened by: Date:
________________________________ ______________

Region XI
BANGOY DISTRICT
INFORMAL ASSESSMENT CHECKLIST IN DIFFICULTY REMEMBERING AND

CONCENTRATING
YES (Y) NO (N)

observed) observed)
Recall facts
learning lists- e.g alphabet
remembering and following verbal
instructions
remembering sight words
sound sequences
trouble studying tests
short attention span
poor memory
difficulty following directions
inability to discriminate
between/among letters, numerals, or
sounds
poor reading and/0r writing ability
eye-hand coordination problems;
poorly coordinated
difficulties with sequencing, and/or
disorganization and other sensory
difficulties
find it hard to remember things
have trouble understanding social
rules
have trouble seeing the results of
their actions
have trouble solving problems
Screened by: Date:
________________________________ ______________
Region XI
BANGOY DISTRICT
INFORMAL ASSESSMENT CHECKLIST ON DIFFICULTY IN PERFORMING ADAPTIVE

SKILLS
YES NO
observed) observed)
Difficulty in dealing with other
children
Acts as deaf
Resists learning
No fear of real dangers
Resists change in routine
Indicates need by gesture
Inappropriate laughing and giggling
Not cuddly
Marked physical over activity
No eye contact
Inappropriate attachments to objects
Spins objects
Sustained odd play
Standoffish manner
High pain tolerance
CONCEPTUAL SKILLS:
Seems forgetful, easily distracted
or daydreaming
Appears not to listen and has trouble
following directions
Interrupts people, blurts things out
inappropriately and may struggle
with nonverbal cues
Acts without thinking and may not
understand the consequences of his
actions
Has obsessive interests and
experiences perseveration
Disobey rules and policies
Fails to finish schoolwork’s
Does not seem to listen when spoken to
Fall asleep easily in class
SOCIAL SKILLS:
Struggles with organization and
completing tasks
May overreact to sensory input, like the
way things sound, smell, taste, look or
feel
Gets upset by changes in routine
Reacts strongly to the way things
sound, smell, taste, look or feel
(sensory processing issues)
Difficulty working independently in
daily chores
Uses eating utensils inappropriately
Unable to put on shoes by himself
Unable to fold clothes
Difficulty in preparing simple meals
Screened by: Date:
____________________________________ _________________

Region XI
BANGOY DISTRICT

INFORMAL ASSESSMENT CHECKLIST ON DIFFICULTY IN INTERPERSONAL BEHAVIOR
YES NO
observed) observed)
Bullies and threatens classmates and
others
Initiates physical fights
Has little empathy for others and has
lack of appropriate feelings of guilt
Lies to peers or teachers
Steals from peers or the school
Shows fearfulness and apprehension
Has difficulty in mingling/interacting
with others
Has low self-esteem masked by
showing boldness intended to impress
or intimidate
Afraid of consequences of activities
Constantly seeks affirmation from
others
Deliberately annoys others
Worries about things that might happen
or have happened
Criticizes self and others
Avoids things or places or refuses to do
things or go places
Expresses feelings of worthlessness,
hopelessness
Blames self and others for one’s
mistakes or misbehavior
Has lack of interest in classroom/school
activities
Thinks or talks repeatedly of suicide
Afraid of failure, rejection and
embarrassment
Avoids work activities that involve
contact with others
Avoids work activities that involve
contact with others
Has the tendency to use and abuse
prohibited drugs and alcohol
Defies and refuses to comply with rules
and teacher's requests
Screened by: Date:
________________________________ ______________
Region XI
BANGOY DISTRICT

INFORMAL ASSESSMENT CHECKLIST ON DIFFICULTY IN SPEECH AND
LANGUAGE
YES NO
observed) observed)
Usually has no speech
If he has spoken, he…
 Uses limited vocabulary
 Speaks in words instead of
sentences
 Is particularly poor in spelling
 Is poor in dictation
 Talks with poor rhythm
Screened by: Date:
________________________________ ______________

Region XI
BANGOY DISTRICT

INFORMAL LEARNING DIFFICULTIES CHECKLIST IN HEARING
YES (Y) NO (N)
observed) observed)
Observation of one or more:
shows strained expression when
listening
be less responsive to noise, voice, or
music
moves closer when talked
watched faces especially the mouth
and lips of the speaker
often asks for repetition when talked
to
delayed or no response to questions
makes us of natural gestures, signs,
and movements
has limited speech
uses limited speech
speaks in words rather in sentences
talks with poor rhythm
difficulty following verbal directions
difficulty with oral expression
difficulty understanding words
especially against background noise
or in a crowd of people
Muffling of speech and other sounds
Frequently asking others to speak
more slowly, clearly and loudly
Needing to turn up the volume of the
television or radio
Withdrawal from conversations
Avoidance of some social settings
NON FORMAL AUDITORY SCREENING TESTS
1. Complete observation checklist
2. Whisper Test – stand or sit the learners 1-2 meters away, back facing his teacher. The teacher says
numbers/words familiar to the learner and asks them to repeat
3. Coin-click tests/noisemakers tests- The learners sits or stands 2-3 meters away, back facing the teacher. The
teacher tosses the coin/noisemaker and instructs the learners to raise their hand every time the clicking of the coin
or sound if the noisemaker is heard.
Screened by: Date:
________________________________ ______________

Region XI
BANGOY DISTRICT

INFORMAL LEARNING DIFFICULTIES CHECKLIST IN WRITING/SPEAKING

YES (Y) NO (N)
observed) observed)
learning to talk
correct articulation (for age)
learning personal information, to

count
most/all curriculum areas
learning letters and words
understanding and responding to
questions
oral expression-retelling events
learning a second language
following instruction, repeating
Reading
general knowledge
writing
counting, matching
phonological skills
questions
Oral expression:
sequencing words in sentence
summarizing information
retelling stories, events
learning a second language
articulation
reading comprehension
reading
decoding
naming words
written language
spelling
phonological skills
questions
poor fine motor skills- writing
legibility
immature grasp/pencil grip
pencil grip
Drawing
letter formation
self-management in the physical
movement e.g. sitting still
physical stamina
physical activity
Coordination
Screened by: Date:
________________________________
______________

Region XI
BANGOY DISTRICT

Teacher: ___________________________ School: _______________________________ Date:
________________
INFORMAL LEARNING DIFFICULTIES CHECKLIST IN MOBILITY

YES (Y) NO (N)
observed) observed)
Restless
Fidgety
Constant repositioning on seat
Fast, cahotic movement
Leaving a seat in situations
Interrupting, blurting out
Difficulty waiting
Difficulty taking turns
poor motor planning skills e.g.
judgement of space
poor gross and fine motor skills
avoids physical activities
reluctant to start work
moves with an unusual gait
judgement of space
playing, singing
dressing and undressing
eating and drinking independently
self-managing of physical
movement- e.g. sitting still
physical stamina
Screened by: Date:
________________________________
______________

Region XI
BANGOY DISTRICT
INFORMAL LEARNING DIFFICULTIES CHECKLIST IN COMMUNICATING

YES (Y) NO (N)
observed) observed)
limited/no language
lengthy monologues
unusual language e.g. echolalia
(repetition of language heard)
modulation
recurring questioning
unusual and speech volume control
undeveloped conversation skills
attention, eye
following instructions, sequencing
literal interpretations of
humor/sarcasm/idioms
gestures; absent to exaggerated
unaware of body language/ facial
expressions of others
lack of response to questions, both
verbal and written
interest in facts/information
judgement of space
playing, singing
dressing and undressing
eating and drinking independently
self-managing of physical
movement- e.g. sitting still
physical stamina
Screened by: Date:
________________________________
______________

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Republic of the Philippines

Name: ______________________________________ Grade/ Level: ________________ LRN #:_______________

INFORMAL ASSESSMENT CHECKLIST IN DIFFICULTY APPLYING KNOWLEDGE

Assessed by: Date:

Republic of the Philippines

Name: ______________________________________ Grade/ Level: ________________ LRN #:_______________

INFORMAL LEARNING DIFFICULTIES CHECKLIST IN VISUAL IMPAIRMENT

turned eyes/eyes-in or out

Screened by: Date:

Republic of the Philippines

INFORMAL ASSESSMENT CHECKLIST IN DIFFICULTY REMEMBERING AND

YES (Y) NO (N)

Screened by: Date:

INFORMAL ASSESSMENT CHECKLIST ON DIFFICULTY IN PERFORMING ADAPTIVE

Screened by: Date:

Republic of the Philippines

Name: ______________________________________ Grade/ Level: ________________ LRN #:_______________

INFORMAL ASSESSMENT CHECKLIST ON DIFFICULTY IN INTERPERSONAL BEHAVIOR

Screened by: Date:

Name: ______________________________________ Grade/ Level: ________________ LRN #:_______________

Screened by: Date:

Republic of the Philippines

Name: ______________________________________ Grade/ Level: ________________ LRN #:_______________

Republic of the Philippines

Name: ______________________________________ Grade/ Level: ________________ LRN #:_______________

INFORMAL LEARNING DIFFICULTIES CHECKLIST IN WRITING/SPEAKING

learning personal information, to

Republic of the Philippines

Name: ______________________________________ Grade/ Level: ________________ LRN #:_______________

INFORMAL LEARNING DIFFICULTIES CHECKLIST IN MOBILITY

Screened by: Date:

Republic of the Philippines

INFORMAL LEARNING DIFFICULTIES CHECKLIST IN COMMUNICATING

Screened by: Date:

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