Child Development Observation Checklist Form
Use this checklist to observe and record key aspects of a child's development. Please complete all items based on your observations.
Observation Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Observer's Name
*
First Name
Last Name
Child's First Name or Initials
*
Age Group
*
Please Select
Infant (0-12 months)
Toddler (1-3 years)
Preschool (3-5 years)
Early School Age (5-7 years)
Other
Communication Skills Observed
*
Responds to name
Uses gestures or words
Follows simple instructions
Engages in conversation
Other
Social Interaction Skills Observed
*
Plays with others
Shares toys or materials
Shows empathy
Participates in group activities
Other
Motor Skills Assessment
*
Rows
Not Observed
Emerging
Developing
Proficient
Walks independently
1
2
3
4
Uses utensils
5
6
7
8
Draws simple shapes
9
10
11
12
Stacks objects
13
14
15
16
Self-Care Skills Observed
*
Feeds self
Dresses/undresses with help
Washes hands
Toileting independently
Other
Attention and Focus
*
1
2
3
4
5
Additional Comments or Observations
Submit Checklist
Should be Empty: