Part 1: Physical disabilities

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Activity 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.

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(a) Cannot, unaided by another person, either:

(i) mobilise more than 50 metres on level ground without stopping in order to avoid significant discomfort or exhaustion;

or

(ii) repeatedly mobilise 50 metres within a reasonable timescale because of significant discomfort or exhaustion.

Score 15

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

Score 9

 

(c) Cannot, unaided by another person, either:

(i) mobilise more than 100 metres on level ground without stopping in order to avoid significant discomfort or exhaustion;

or

(ii) repeatedly mobilise 100 metres within a reasonable timescale because of significant discomfort or exhaustion.

Score 9

 

(d) Cannot, unaided by another person, 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 metres within a reasonable timescale because of significant discomfort or exhaustion.

Score 6

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(e) None of the above applies. 

Score 0

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Activity 2: Standing and sitting

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

(b) 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) for more than 30 minutes, before needing to move away in order to avoid significant discomfort or exhaustion.

9 Points

(c) 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) for more than an hour before needing to move away in order to avoid significant discomfort or exhaustion.

6 points

(d) None of the above apply
0 Points

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Activity 3: Reaching

 

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

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

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

(d) None of the above apply.
0 Points

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Activity 4: Picking up and moving or transferring by the use of the upper body and arms

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

(b) Cannot pick up and move a one litre carton full of liquid

9 Points

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

(d) None of the above apply
0 points

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Activity 5: Manual dexterity

(a) Cannot either:

(i) press a button, such as a telephone keypad; or (ii) turn the pages of a book
with either hand.

15 Points

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(b) Cannot pick up a £1 coin or equivalent with either hand.
15 Points

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

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(d) Cannot use a suitable keyboard or mouse.
9 Points

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(e) None of the above apply.
0 Points

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Activity 6: Making self understood through speaking, writing, typing, or other means normally used, unaided by another person

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

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

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

(d) None of the above apply.
0 points

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Activity 7: Understanding communication by both verbal means (such as hearing or lip reading) and non-verbal means (such as reading 16 point print) using any aid it is reasonable to expect them to use, unaided by another person

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

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

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

(d) None of the above apply.
0 Points

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Activity 8: Navigation and maintaining safety, using a guide dog or other aid if normally used

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

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

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

(d) None of the above apply.
0 Points

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Activity 9: Absence or loss of control leading to extensive evacuation of the bowel and/or bladder, other than enuresis (bed-wetting) despite the presence of any aids or adaptations normally used

(a) 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

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(b) 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

(c) None of the above apply.
0 Points

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Activity 10: Consciousness during waking moments

 

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

 

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

(c) None of the above apply.
0 Points

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Part 2: Mental, cognitive and intellectual function assessment

 

Activity 11: Learning tasks

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

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

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

(d) None of the above apply.
0 Points

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Activity 12: Awareness of everyday hazards (such as boiling water or sharp objects)

(a) 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

 

(b) 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

 

(c) 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

 

(d) None of the above apply.
0 Points

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

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

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

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

(d) None of the above apply.
0 Points

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Activity 14: Coping with change

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

(b) 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

(c) 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

(d) None of the above apply.
0 Points

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Activity 15: Getting about

(a) Cannot get to any specified place with which the claimant is familiar.
15 Points

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

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

(d) None of the above apply.
0 Points

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Activity 16: Coping with social engagement due to cognitive impairment or mental disorder

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

(b) 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

(c) 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

(d) None of the above apply.
0 Points

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Activity 17: Appropriateness of behaviour with other people, due to cognitive impairment or mental disorder

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

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

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

(d) None of the above apply.
0 Points

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