Work Capability self-assessment

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This page relates to the physical test for the work-related activity group

1. Mobilising unaided by another person with or without a walking stick, manual wheelchair or other aid if such aid is normally, or could reasonably be, worn or used*

1a. Cannot either (i) mobilise more than 50 meters on level ground without stopping in order to avoid significant discomfort or exhaustion or (ii) repeatedly mobilise 50 meters within a reasonable timescale because of significant discomfort or exhaustion. (15 points)

1b. Cannot mount or descend two steps unaided by another person even with the support of a handrail. (9 points)

1c. Cannot either (i) mobilise more than 100 meters on level ground without stopping in order to avoid significant discomfort or exhaustion or (ii) repeatedly mobilise 100 meters within a reasonable timescale because of significant discomfort or exhaustion. (9 points)

1d. Cannot either (i) mobilise more than 200 metres on level ground without stopping in order to avoid significant discomfort or exhaustion or (ii) repeatedly mobilise 200 meters within a reasonable timescale because of significant discomfort or exhaustion. (6 points)

1e. None of the above apply. (0 points)

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2. Standing and sitting*

2a. Cannot move between one seated position and another seated position located next to one another without receiving physical assistance from another person. (15 points)

2b. Cannot, for the majority of the time, remain at a work station, either: (i) standing unassisted by another person (even if free to move around) or; (ii) sitting (even in an adjustable chair); or (iii) a combination of (i) and (ii), for more than 30 minutes, before needing to move away in order to avoid significant discomfort or exhaustion. (9 points)

2c. Cannot, for the majority of the time, remain at a work station, either: (i) standing unassisted by another person (even if free to move around) or; (ii) sitting (even in an adjustable chair); or (iii) a combination of (i) and (ii), for more than an hour, before needing to move away in order to avoid significant discomfort or exhaustion. (6 points)

2d. None of the above apply. (0 points)

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3. Reaching*

3a. Cannot raise either arm as if to put something in the top pocket of a coat or jacket. (15 points)

3b. Cannot raise either arm to top of head as if to put on a hat. (9 points)

3c. Cannot raise either arm above head height as if to reach for something. (6 points)

3d. None of the above apply. (0 points)

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4. Picking up and moving or transferring by the use of the upper body and arms*

4a. Cannot pick up and move a 0.5 litre carton full of liquid. (15 points)

4b. Cannot pick up and move a one litre carton full of liquid. (9 points)

4c. Cannot transfer a light but bulky object such as an empty cardboard box. (6 points)

4d. None of the above apply. (0 points)

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5. Manual dexterity*

5a. Cannot either: (i) press a button, such as a telephone keypad or; (ii) turn the pages of a book with either hand. (15 points)

5b. Cannot pick up a 1 pound coin or equivalent with either hand. (15 points)

5c. Cannot use a pen or pencil to make a meaningful mark. (9 points)

5d. Cannot single-handedly use a suitable keyboard or mouse. (9 points)

5e. None of the above apply. (0 points)

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6. Making self understood through speaking, writing, typing, or other means which are normally, or could reasonably be, used, unaided by another person*

6a. Cannot convey a simple message, such as the presence of a hazard. (15 points)

6b. Has significant difficulty conveying a simple message to strangers. (15 points)

6c. Has some difficulty conveying a simple message to strangers. (6 points)

6d. None of the above apply. (0 points)

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7. Understanding communication by: (a) verbal means (such as hearing or lip reading) alone, (b) non-verbal means (such as reading 16 point print or Braille) alone, or (c) a combination of (a) and (b), using any aid that is normally, or could reasonably be, used, unaided by another person*

7a. Cannot understand a simple message due to sensory impairment, such as the location of a fire escape. (15 points)

7b. Has significant difficulty understanding a simple message from a stranger due to sensory impairment. (15 points)

7c. Has some difficulty understanding a simple message from a stranger due to sensory impairment. (6 points)

7d. None of the above apply. (0 points)

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8. Navigation and maintaining safety, using a guide dog or other aid if either or both are normally, or could reasonably be, used*

8a. Unable to navigate around familiar surroundings, without being accompanied by another person, due to sensory impairment. (15 points)

8b. Cannot safely complete a potentially hazardous task such as crossing the road, without being accompanied by another person, due to sensory impairment. (15 points)

8c. Unable to navigate around unfamiliar surroundings, without being accompanied by another person, due to sensory impairment. (9 points)

8d. None of the above apply. (0 points)

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9. Absence or loss of control whilst conscious leading to extensive evacuation of the bowel and/or bladder, other than enuresis (bed-wetting), despite the wearing or use of any aids or adaptations which are normally, or could reasonably be, worn or used*

9a. At least once a month experiences (i) loss of control leading to extensive evacuation of the bowel and/or voiding of the bladder; or (ii) substantial leakage of the contents of a collecting device; sufficient to require cleaning and a change in clothing. (15 points)

9b. The majority of the time is at risk of loss of control leading to extensive evacuation of the bowel and/or voiding of the bladder, sufficient to require cleaning and a change in clothing, if not able to reach a toilet quickly. (6 points)

9c. None of the above apply. (0 points)

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10. Consciousness during waking moments*

10a. At least once a week, has an involuntary episode of lost or altered consciousness resulting in significantly disrupted awareness or concentration. (15 points)

10b. At least once a month, has an involuntary episode of lost or altered consciousness resulting in significantly disrupted awareness or concentration. (6 points)

10c. None of the above apply. (0 points)

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This page relates to the mental health test for the work-related activity group

11. Learning tasks*

11a. Cannot learn how to complete a simple task, such as setting an alarm clock. (15 points)

11b. Cannot learn anything beyond a simple task, such as setting an alarm clock. (9 points)

11c. Cannot learn anything beyond a moderately complex task, such as the steps involved in operating a washing machine to clean clothes. (6 points)

11d. None of the above apply. (0 points)

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12. Awareness of everyday hazards (such as boiling water or sharp objects)*

12a. Reduced awareness of everyday hazards leads to a significant risk of: (i) injury to self or others; or (ii) damage to property or possessions, such that they require supervision for the majority of the time to maintain safety. (15 points)

12b. Reduced awareness of everyday hazards leads to a significant risk of (i) injury to self or others; or (ii) damage to property or possessions, such that they frequently require supervision to maintain safety. (9 points)

12c. Reduced awareness of everyday hazards leads to a significant risk of: (i) injury to self or others; or (ii) damage to property or possessions, such that they occasionally require supervision to maintain safety. (6 points)

12d. None of the above apply. (0 points)

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13. Initiating and completing personal action (which means planning, organisation, problem solving, prioritising or switching tasks)*

13a. Cannot, due to impaired mental function, reliably initiate or complete at least 2 sequential personal actions. (15 points)

13b. Cannot, due to impaired mental function, reliably initiate or complete at least 2 personal actions for the majority of the time. (9 points)

13c. Frequently cannot, due to impaired mental function, reliably initiate or complete at least 2 personal actions. (6 points)

13d. None of the above apply. (0 points)

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14. Coping with change*

14a. Cannot cope with any change to the extent that day to day life cannot be managed. (15 points)

14b. Cannot cope with minor planned change (such as a pre-arranged change to the routine time scheduled for a lunch break), to the extent that overall day to day life is made significantly more difficult. (9 points)

14c. Cannot cope with minor unplanned change (such as the timing of an appointment on the day it is due to occur), to the extent that overall, day to day life is made significantly more difficult. (6 points)

14d. None of the above apply. (0 points)

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15. Getting about*

15a. Cannot get to any place outside the claimant's home with which the claimant is familiar. (15 points)

15b. Is unable to get to a specified place with which the claimant is familiar, without being accompanied by another person. (9 points)

15c. Is unable to get to a specified place with which the claimant is unfamiliar without being accompanied by another person. (6 points)

15d. None of the above apply. (0 points)

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16. Coping with social engagement due to cognitive impairment or mental disorder*

16a. Engagement in social contact is always precluded due to difficulty relating to others or significant distress experienced by the individual. (15 points)

16b. Engagement in social contact with someone unfamiliar to the claimant is always precluded due to difficulty relating to others or significant distress experienced by the individual. (9 points)

16c. Engagement in social contact with someone unfamiliar to the claimant is not possible for the majority of the time due to difficulty relating to others or significant distress experienced by the individual. (6 points)

16d. None of the above apply. (0 points)

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17. Appropriateness of behaviour with other people, due to cognitive impairment or mental disorder*

17a. Has, on a daily basis, uncontrollable episodes of aggressive or disinhibited behaviour that would be unreasonable in any workplace. (15 points)

17b. Frequently has uncontrollable episodes of aggressive or disinhibited behaviour that would be unreasonable in any workplace. (15 points)

17c. Occasionally has uncontrollable episodes of aggressive or disinhibited behaviour that would be unreasonable in any workplace. (9 points)

17d. None of the above apply. (0 points)

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This page relates to the additional support group descriptors: you've already done most of the support group test as it overlaps with many of the highest scoring descriptors on the preceding two pages

18. Absence or loss of control over extensive evacuation of the bowel and/or bladder, other than enuresis (bed-wetting) despite the presence of any aids or adaptations normally used*

18a. At least once a week experiences (i) loss of control leading to extensive evacuation of the bowel and/or voiding of the bladder; or (ii) substantial leakage of the contents of a collecting device; sufficient to require the individual to clean themselves and change clothing.

18b. This does not apply to me.

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19. Conveying food or drink to the mouth*

19a. Cannot convey food or drink to the claimant's own mouth without receiving physical assistance from someone else;

19b. Cannot convey food or drink to the claimant's own mouth without repeatedly stopping, experiencing breathlessness or severe discomfort;

19c. Cannot convey food or drink to the claimant's own mouth without receiving regular prompting given by someone else in the claimant's physical presence; or

19d. Owing to a severe disorder of mood or behaviour, fails to convey food or drink to the claimant's own mouth without receiving - (i) physical assistance from someone else; or (ii) regular prompting given by someone else in the claimant's presence.

19e. This does not apply to me.

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20. Chewing or swallowing food or drink*

20a. Cannot chew or swallow food or drink;

20b. Cannot chew or swallow food or drink without repeatedly stopping, experiencing breathlessness or severe discomfort;

20c. Cannot chew or swallow food or drink without repeatedly receiving regular prompting given by someone else in the claimant's presence; or

20d. Owing to a severe disorder of mood or behaviour, fails to- (i) chew or swallow food or drink; or (ii) chew or swallow food or drink without regular prompting given by another person in the physical presence of the claimant.

20e. This does not apply to me.

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This page relates to exemptions, exceptional circumstances and treatment in relation to the work-related activity group and the support group

21. You are terminally ill and your death can reasonably be expected within 6 months*

21a. Yes

21b. No

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22. You are receiving treatment for cancer by way of chemotherapy or radiotherapy; or you are likely to receive such treatment within 6 months; or you are recovering from such treatment*

22a. Yes

22b. No

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23. You have a notifiable disease or have been in contact with someone with a notifiable disease*

23a. Yes

23b. No

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24. You are a pregnant woman and there is a serious risk of damage to your health or to the health of your unborn child if you do not refrain from work/work-related activity*

24a. Yes

24b. No

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25. You are a pregnant woman entitled to maternity allowance*

25a. Yes

25b. No

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26. You are a pregnant woman within 6 weeks of your expected confinement date or 14 days after the date of your confinement where you don't have any entitlement to maternity allowance or statutory maternity pay*

26a. Yes

26b. No

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27. You are suffering from a life threatening disease which is uncontrollable or uncontrolled by a recognised therapeutic procedure*

27a. Yes

27b. No

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28. Because of your physical or mental health condition or learning disability, there would be a substantial risk to the mental or physical health of any person, including you, if you were found not to have limited capability for work. And the risk could not be reduced by a significant amount by reasonable adjustments being made in your workplace or by your taking medication to manage your condition that has been prescribed by a registered medical practitioner who is treating you*

28a. Yes

28b. No

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29. Because of your physical or mental health condition or learning disability, there would be a substantial risk to the mental or physical health of any person, including you, if you were found not to have limited capability for work-related activity*

29a. Yes

29b. No

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30. You will be regarded as having limited capability for work on any days in which you are an in-patient in hospital or recovering from in-patient treatment or where you are attending residential rehabilitation for the treatment of drug or alcohol addiction. Does this apply to you?*

30a. Yes

30b. No

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31. You will be regarded as having limited capability for work on any days in which you are receiving, or recovering from receiving, certain regular treatments: plasmapherisis; haemodialysis; radiotherapy or total parenteral nutrition. Are you having any such treatment?*

31a. Yes

31b. No

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Work Capability self-assessment

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