The 4D Behavior Screening Checklist

A Contextualized Frontline Behavioral Screening Tool for Filipino Learners

Paggabay sa Pagsusuri (Sikolohiyang Pilipino): Assess behaviors through the lens of local student expression. A quiet or non-responsive student may be practicing respectful compliance (paggalang) or internalization due to fear of losing face (hiya). Practice empathetic, intuitive clinical scanning (pakikiramdam) to identify silent suffering from material poverty or emotional distress.

Student Name (Pangalan)

Learner Reference Number (LRN)

Grade & Section (Baitang)

Class Adviser (Guro)

Instructions for Class Advisers

Observe the student's behavior patterns inside school/classroom settings over a consistent observation window (e.g., 5 to 10 consecutive school days). Check the appropriate score (1 to 5) that best represents the frequency of the observed action. Calculate the total scores below to map out the matching multi-tiered supportive pathways.

Never

Hindi kailanman

Seldom

Bihira

Sometimes

Paminsan-minsan

Often

Madalas

Always

Palagi

Domain 1: Disengagement (Academic Withdrawal)

Pagbaba ng Pakikilahok

#	Observed Behavioral Indicators	Frequency Score Rating (1 - 5)
1	Slumps in seat, stares blankly, or sleeps during core instructional discussions. Lutang / Walang focus	1 2 3 4 5
2	Fails to submit written works, assignments, or required performance tasks on time. Walang naipapasa	1 2 3 4 5
3	Shies away from active oral recitation, paired drills, or voluntary board activities. Umiiwas sa klase	1 2 3 4 5
4	Gives up quickly when faced with complex learning tasks (e.g., drops pen, complains of fatigue). Madaling sumuko	1 2 3 4 5
5	Requires persistent individual verbal prompts from the teacher to begin or complete simple work. Kailangan laging bantay	1 2 3 4 5

Domain 2: Disconnection (Social / Relational Isolation)

Paglayo sa Kapwa

#	Observed Behavioral Indicators	Frequency Score Rating (1 - 5)
6	Spends unstructured recess or lunch periods entirely alone, avoiding normal peer banter. Nag-iisa sa breaktime	1 2 3 4 5
7	Actively objects to pairing up or working collaboratively during group dynamic tasks. Ayaw makipag-grupo	1 2 3 4 5
8	Displays a flat affect or lacks reactive emotional expression when addressed by peers. Walang pakiramdam / Matipid	1 2 3 4 5
9	Shuts down completely when queried about social or emotional stressors, refusing to lock eyes. Umiiwas makipag-usap	1 2 3 4 5
10	Declines joining school-wide milestones or classroom group social activities. Hindi sumasali sa programa	1 2 3 4 5

Domain 3: Disruption (Active Classroom Disturbance)

Panggugulo sa Klase

#	Observed Behavioral Indicators	Frequency Score Rating (1 - 5)
11	Interjects with loud, unprompted remarks that challenge lesson progress or lecture flow. Sumasabat sa guro	1 2 3 4 5
12	Leaves desk assignment zone or paces around the classroom without explicit permission. Laging umaalis sa upuan	1 2 3 4 5
13	Demonstrates immediate explosive physical/verbal frustration when corrected by the teacher. Madaling magalit	1 2 3 4 5
14	Engages in active, targeted teasing, verbal friction, or bickering with classmates. Nang-aasar o nakikipag-away	1 2 3 4 5
15	Shows defiance or structural refusal toward standard, straightforward school safety protocols. Suwail sa patakaran	1 2 3 4 5

Domain 4: Deterioration (Acute Physical / Emotional Decline)

Kritikal / Pagbagsak ng Kalagayan

#	Observed Behavioral Indicators	Frequency Score Rating (1 - 5)
16	Presents a sudden, drastic neglect in basic grooming, personal hygiene, or uniform care. Marungis / Napabayaan ang sarili	1 2 3 4 5
17	Displays visible somatic breakdowns in class (e.g., rapid shaking, sudden crying fits, extreme panic). Biglang umiiyak / Nanginginig	1 2 3 4 5
18	Sleeps persistently across various subject periods; shows extreme lethargy or chronic eye redness. Laging tulog / Sobrang pagod	1 2 3 4 5
19	Complains of recurring physical pains (e.g., headache, gut cramps) without an established organic source. Laging masakit ang ulo/tiyan	1 2 3 4 5
20	Exhibits disassociated behavior patterns or complete failure to track immediate environmental realties. Tuluyan nang lumayo ang isip	1 2 3 4 5

Behavior Screening Analytics

Calculated score ranges group student behaviors into distinct MTSS referral support paths. Retain secure logs for subsequent multidisciplinary guidance meetings.

out of 100

Tier 1: Stable

Recommended Action Protocol

Please answer all checklist questions. The system will immediately provide a culturally aligned support framework.

Maria Santos, LPT

Class Adviser / Frontline Evaluator

Registered Guidance Counselor / Special Ed Lead

Validating Professional / Coordinator