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Observer:
DOB:
Dates:
Program:
Directions:
Put a for items you see the child perform regularly. Put N for items where there is
no opportunity to observe. Leave all others blank.
Item
Evidence
Date
1. Self-Esteem
___ Separate from primary
caregivers without difficulty
___ Develop a secire
attachment with teacher
___ Complete a task
successfully
___ Make activity choices
without teachers help
___ Stand up for own rights
___ Display enthusiasm about
doing things for self
___ Be observed by using
running record and checklist
2. Emotional Competence
___ Release stressful feelings
in appropriate manner
___ Experss anger in words
rather than negative actions
___ Be calmed in frightening
situations
___ Shows fondness, affection,
love toward others
___ Shows interest/attention in
classroom activities
___ Smiles seems happy much
of the time
___ Be observed by using
sampling and checklist
3. Social Competence
___ Plays by self with own
toys/materials
___ Plays parallel to others with
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Item
Evidence
Date
similar toys/materials
___ Plays with others in group
play
___ Gains access to play in a
positive manner
___ Makes friends with other
children
___ Resolves play conflicts in a
positive manner
___ Be observed by using
running records and checklist
4. Physical Development
___ Runs with control over
speed and direction
___ Climbs up and down
climbing equipment with ease
___ Throws, catches and kicks
___ Turns knobs, lids, and
eggbeaters
___ Pick up and insert objects
with dexterity
___ Use tools (scissors,
hammers) with control
___ Be observed by using
rating scales and checklist
5. Cognitive Development
___ Classify objects by shape,
color, size
___ Places objects in a
sequence or series
___ Counts by rote up to 20
___ Display 1-to-1
correspondence with numbers
___ Problem solve with
concrete objects
___ Make thinking visible
___ Be observed by using
rating scales and checklist
6. Spoken Language
___ Listens but does not speak
___ Gives single word, short
phrase response
___ Takes part in conversations
___ Speaks in expanded
sentences
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Item
Evidence
Date
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Item
Evidence
Date
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