Examiner's Notes: Write Down Your Notes, Descriptions and Observation On The Columns Provided
Examiner's Notes: Write Down Your Notes, Descriptions and Observation On The Columns Provided
Examiner's Notes: Write Down Your Notes, Descriptions and Observation On The Columns Provided
Write down your notes, descriptions and observation on the columns provided.
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.)