ESA - filling out the Limited Capability to Work questionnaire

Please note that this information is aimed at people who are deafblind and those people who support them. General information including where to return completed ESA forms and other related contact details can be found here

Once you have made a claim for Employment and Support Allowance (ESA) by completing an ESA1 form, you will be sent a questionnaire called the Limited Capability for Work questionnaire. This form is known as ESA50.

What is the Limited Capability for Work Questionnaire (ESA50)?

The ESA50 is sent to people who have made a claim for ESA. It is your signed statement of needs and it is important that you answer the questions fully.

The information below gives advice on how to complete the ESA50 form.

Do I have to fill in all the questions?

The form is divided up into standard questions and specific questions about your illness or disability. You should fill in each question with as much detail as is possible, although not all of the questions will necessarily apply to you.

Pages 1–6: Standard Questions

You should answer all of these standard questions.

Page 1: This page contains the guidance for filling out the ESA50, and recommends that you set aside enough time to fill out the form fully as it may take some time.

Page 2: Fill out all of your basic details such as name, address, date of birth and national insurance number.

Page 3: You do not have to give a telephone number relating to 'face to face assessments'. If you can't talk on the phone you can give a support worker or carer's number. Otherwise you can state 'in writing please'.

If you need to bring an interpreter with you, for example a BSL interpreter, state this on page 3. State whether you want to bring your own interpreter, which can be a family member or friend, or whether you want one arranged for you.

If you would need to take somebody with you to an assessment, for example a family member, friend or support worker, you should state this at the bottom of page 3. The person you decide to bring with you can either come into the assessment or wait outside, it is your choice.

Page 4: You are asked for details of your GP. It is important that you fill this in. If there are lots of GPs at a doctor's surgery, put the one who will know you best or understand your case the best.

You are also asked about details of your specialist. If you see more than one specialist, write 'see attached sheet' and write the details of all of your specialists on a separate piece of plain paper. Enclose this with your form, remembering to write your name and national insurance number on each separate sheet you add.

Page 5: You are asked about your illnesses or disabilities. Use this page to list your conditions. Try to put an approximate date when the condition began and remember to include details of any medication you are currently taking.

You are asked how your condition varies. This is very difficult to answer in such a small box, so it is acceptable to write 'I will explain how my condition affects me day to day under each question in the rest of the form'. There is plenty of space later in the form to give more detail.

Page 6: You are asked about hospitals, clinics and special treatment. It is important to write down details of any hospitals or clinics you attend. If you are not sure whether something is relevant, write it down anyway as it is better not to miss things out.

You are also asked about alcohol and substance misuse. If you think this section applies to you, remember to fill out details of any help you are getting. You can also contact the Sense Information and Advice Service for advice on how to approach this answer, details of which are given below.

Numbered Questions: Page 7 onwards

From page 7, questions will be numbered. These headings are called 'descriptors'. Points can be awarded under each descriptor that applies to you depending on what level of difficulty you have with that task. You do not need to score points under each question and they may not all apply to you. You need to score a total of 15 points or more to be awarded ESA.

The questions on the ESA50 do not relate exactly to the legal test. It is helpful to view our separate information, 'ESA Descriptors' whilst filling out your answers as this contains the tests that the assessor will use when reading your form.

Our 'ESA Descriptors' information also lists the points available under each descriptor.

Sometimes the questions allow you to tick a box titled 'It varies'. Even if your conditions do fluctuate (in that they vary or are irregular in nature), don't rule out any of the options straight away. The only time you should tick 'It varies' is if none of the other boxes could apply.

Ask yourself if one of the other boxes could apply for a lot of the time – decide which option applies to you more of the time than the other options. You can then use the space below to explain any variations in your conditions.

You will be asked if you 'cannot' do certain activities. It is very important to remember that 'cannot do something' means 'cannot safely, reliably and repeatedly do it most of the time'. This means that if you can carry out the activity but it would be unsafe, you could not do it repeatedly or you could not complete the activity reliably, you should tick that you cannot do that particular activity.

Example One

Priyam is considering a question on the form which asks him whether he can get around places he doesn't know very well on his own. Although he does sometimes visit places he doesn't know very well, he feels very unsafe when he does so as he cannot hear traffic or see cars clearly. For these reasons, Priyam cannot get around places he doesn't know very well on his own as he cannot do this safely.

Example Two

Helena is considering a question that asks whether she can move 50 metres. Although she can physically move herself 50 metres, she cannot do this safely as she risks falling over or not seeing objects in her path. For this reason, she cannot walk 50 metres as she cannot do it safely.

Part 1 – Physical Functions (pages 7 – 12)

Part 1 covers questions 1 to 10. These questions relate to physical functions only. Mental health functions are dealt with in Part 2.

Question 1: Moving around and using steps. You are asked to tick how far you can move without needing to stop. It is important to ask yourself which of the options apply more than the other options on most days i.e. 50m, 100m or 200m. Remember that if it varies, you can explain this in the space below. It may vary from day to day, or it may vary from one time of the day to another. Explain how it varies in the space below the question.

If you walk with an aid, including wheelchairs and guide dogs, you should answer this question as if you were using that aid. If you have difficulty using the aid on your own you should write this in the space below the question.

Remember this question is about the act of moving 50m/100m/200m both indoors and outdoors. There is a separate question (question 8) about 'getting around safely' regarding any sensory impairments you may have.

Remember to look at the 'ESA Descriptors' Sense information for the legal test that is used for this question. Decide which part of the ESA descriptor applies most to you and apply that to your answer.

Question 2: Standing and sitting. You are asked how long you can sit or stand without pain or exhaustion: less than 30 minutes, 30 minutes to 1 hour or more than 1 hour. Think realistically about how long you can sit or stand in one place. Do not count the time that you would be uncomfortable doing so.

Remember to look at the 'ESA Descriptors' Sense information for the legal test that is used for this question. Decide which part of the ESA descriptor applies most to you and apply that to your answer.

Question 3: Reaching. You are asked about different methods of reaching. This question looks at both arms together. Points can only be scored if you can't do these tasks with either arm. If one arm is worse than the other you need to think about whether you can do these tasks with your better arm.

Remember if you cannot do it safely, reliably and repeatedly most days then you need to make that clear and you should not be treated as if you can do it.

Remember to look at the 'ESA Descriptors' Sense Information for the legal test that is used for this question. Decide which part of the ESA descriptor applies most to you and apply that to your answer.

Question 4: Picking up and moving things. The same advice applies as in question 3 – the question looks at both hands.

Remember to look at the 'ESA Descriptors' Sense information for the legal test that is used for this question. Decide which part of the ESA descriptor applies most to you and apply that to your answer.

Question 5: Manual dexterity. You are asked whether you can do any of the listed activities. If you ticked 'some of these things', remember to explain which ones. Think about both hands, as if you can do these tasks with one of your hands you will not qualify for any points for this question.

Remember to look at the 'ESA Descriptors' Sense information for the legal test that is used for this question. Decide which part of the ESA descriptor applies most to you and apply that to your answer.

Question 6: Communicating with people. This is a question relevant to most deafblind people. When ticking yes or no as to whether you have any difficulties, remember that communication has to be 'consistent and reliable'.

You are asked if you can communicate a simple message to other people, such as the presence of something dangerous. If you rely on another person to communicate you should tick 'No'.

If you rely on others knowing your method of communication, for example BSL, you can tick 'No' and explain in the box that you rely on others knowing BSL in order to communicate.

Remember to look at the 'ESA Descriptors' Sense information for the legal test that is used for this question. Decide which part of the ESA descriptor applies most to you and apply that to your answer.

Question 7: Other people communicating with you. Your ability to understand has to be consistent and reliable, so always consider this when you are asked whether you have any difficulty.

Sight and/or hearing problems count. You do not need to have a problem with both to score points for this question. If you rely on lip reading remember to think about any limitations or problems with that and mention them. Does your ability to lip read depend on whether it is with someone you know well? Does it rely on lighting?

Remember to look at the 'ESA Descriptors' Sense information for the legal test that is used for this question. Decide which part of the ESA descriptor applies most to you and apply that to your answer.

Question 8: Getting around safely. This question is misleading as it only asks about eyesight. The question in the legal test is about 'sensory problems' with getting around safely. This means that hearing problems can count too.

Remember that the activity should be able to be done safely, reliably and repeatedly. This means that if you can cross a road but it is unsafe because you can't always hear or see oncoming traffic, you should tick that you cannot cross the road on your own.

Remember to look at the 'ESA Descriptors' Sense information for the legal test that is used for this question. Decide which part of the ESA descriptor applies most to you and apply that to your answer.

Question 9: Controlling your bladder and bowels and using a collecting device. If the problem is variable think about whether it is weekly most of the time or monthly most of the time. Tick the box that is accurate 'most of the time' - it is important because it could determine what level of ESA you are awarded. You can explain any variability in the space below.

If you are at risk of incontinence and need to stay close to a toilet for this reason you can still get points even if you manage to avoid accidents by doing so - you need to explain this in the box.

Remember to look at the 'ESA Descriptors' Sense information for the legal test that is used for this question. Decide which part of the ESA descriptor applies most to you and apply that to your answer.

Question 10: Staying conscious while awake. You should include episodes where you do not know what is going on around you or you are very confused about what is going on around you.

It is misleading just to ask about 'fits, faints and blackouts' - for example if your sugar levels are too high or too low and you are diabetic you may still be conscious but could be unsafe due to confusion or reduced awareness. Think about whether anything like this applies to you.

Remember to look at the 'ESA Descriptors' Sense information for the legal test that is used for this question. Decide which part of the ESA descriptor applies most to you and apply that to your answer.

Part 2: Mental, Cognitive and Intellectual functions

Question 11: Learning how to do tasks. If you frequently have to be reminded to do simple tasks, you should tick 'No' and explain in the box below. The test in this question gives using a washing machine as an example of a moderately complex task as learning how to use one includes understanding about what setting is appropriate for which clothes without prompting every time.

Remember to look at the 'ESA Descriptors' Sense information for the legal test that is used for this question. Decide which part of the ESA descriptor applies most to you and apply that to your answer.

Question 12: Awareness of hazards or danger. You are asked if you can stay safe when doing everyday tasks. If you can stay safe sometimes, but not all of the time, do not tick that you can complete tasks safely.

You are also asked if you need supervision from somebody to stay safe. Even if you do not have somebody who supervises you, you should still put down why you are at risk. The question focuses on your awareness of risk, and not whether you already receive help or supervision.

The question addresses whether you can keep yourself safe. The legal test also includes damage to property or injury to other people, so if your awareness of hazards or danger could cause damage to property or other people you should also write this on the form.

Remember to look at the 'ESA Descriptors' Sense Information for the legal test that is used for this question. Decide which part of the ESA descriptor applies most to you and apply that to your answer.

Question 13: Starting and finishing tasks. If you cannot do things in a logical order due to distraction, confusion or lack of concentration, make this very clear.

You are asked if you can manage to plan, start and finish daily tasks. If you 'cannot' most of the time, then 'never' is the closest option.

In the notes box, you can address the whole process from thinking, planning and organising doing something from starting to do it right through to finishing it. If you normally need help or prompting then you should tick 'never' and explain the problem. It can include daily tasks like washing, dressing, housework, dealing with correspondences or making/attending appointments.

Remember to look at the 'ESA Descriptors' Sense Information for the legal test that is used for this question. Decide which part of the ESA descriptor applies most to you and apply that to your answer.

Question 14: Coping with changes. You are asked to tick the box if you can cope with changes to your daily routine. If you have some problems with this, do not tick this box and look further down into the question.

You are asked whether you can cope with small changes to your routine if you know about them before they happen. You should tick 'No' if you cannot deal with change on any level, even if you are warned about it. Try and explain how you react to change, and how long it takes you to adapt to small changes.

The second question is about small unexpected change. You might have problems with small unexpected changes if it takes a lot of planning and mental preparation to get ready for something, and you then find it hard to cope when it is cancelled. This is just an example. Try to explain by giving examples of what happens to you.

Remember to look at the 'ESA Descriptors' Sense Information for the legal test that is used for this question. Decide which part of the ESA descriptor applies most to you and apply that to your answer.

Question 15: Going out. This question is about your ability to cope mentally or emotionally with going out. If you have physical problems with going out, address this in Part 1 of the form.

Remember the above guidance on ticking the box entitled 'It varies'.

Tick 'No' if most of the time you cannot leave home and go to places you do not know. If you have no-one to go with you so you struggle to do it, talk about any difficulties you get into – for example, panic attacks, getting lost or the risk of road accidents.

Remember to look at the 'ESA Descriptors' Sense Information for the legal test that is used for this question. Decide which part of the ESA descriptor applies most to you and apply that to your answer.

Question 16: Coping with social situations. If you often have difficulties talking to or spending time with people even if you know them well make this clear.

Coping with social situations means more than managing to be in the same room as people. If you can do this but you can't talk face to face with anyone in the room, or you can only do it if someone you know is with you, explain why and give examples.

If you need someone you know to be with you to manage this then the answer is 'No'.

Remember to look at the 'ESA Descriptors' Sense Information for the legal test that is used for this question. Decide which part of the ESA descriptor applies most to you and apply that to your answer.

Question 17: Behaving appropriately. The DWP need to know whether you behave aggressive in an uncontrolled way or whether you behave inappropriately and/or strangely in front of other people.

Remember to look at the 'ESA Descriptors' Sense Information for the legal test that is used for this question. Decide which part of the ESA descriptor applies most to you and apply that to your answer.

Part 3

Question 18: Eating and drinking. Part 3 relates only to question 18 and it is very important that you fill this in accurately if it applies to you, as it is a determining factor in being placed into the 'support group' (see the separate Sense 'ESA Information' to find information on support groups). Remember that if it varies, you can explain this in the space below.

Both of the questions include physical problems that you might have. They also include problems like forgetting to eat and drink or refusing to eat without prompting, as well as needing to be encouraged to swallow food and drink.

This could be because of a problem with your hands or arms or because of mental distraction or confusion.

This is the end of the questions relating to your needs.

Including other information

Page 17 of the ESA50 does not tell you to include any additional evidence or information but if you have letters from consultants or specialists about your diagnosis or condition you should attach copies to the form. This also applies to other types of information like a GP's letter or an occupational health assessment. If you do include any of these reports, list what you have included on page 17.

You can also add any additional information you want to tell the DWP about. Remember that if you want to add any further information to any of the questions, you can also use a separate sheet of paper and attach it to your form. Remember to write your name and national insurance number on each piece of paper attached to the form.

Page 18 asks you to sign and date the declaration. It is very important that the form is signed and dated, as if either of the boxes are not filled in your application will be sent back to you.

The form states that it may be helpful to take a photocopy of your ESA50. We recommend photocopying your final completed ESA50 as well as any supporting evidence that you send to keep for your records but send the original.

If you are filling in the form for somebody else, page 18 asks for your details.

Page 19 asks you to tick the box if you are including any medical evidence. It also asks if you would like somebody else to be informed of your assessment instead of you. You may want to nominate somebody else to be told about your assessment, for example if you think they may be in a better position to receive the information quickly and contact you to avoid delays.

Page 20 is relevant if you are waiting for, having or recovering from cancer treatment and, if this applies to you, should be filled out by your GP.

If you are somebody who is deafblind, or are supporting somebody who is, and have any questions about your ESA form which are not answered by this fact sheet, you can contact the Sense Information and Advice Service.

First published: Wednesday 15 January 2014
Updated: Tuesday 29 November 2016