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.

1(a)

Cannot, unaided by another person, either:

15

(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.

(b)

Cannot, unaided by another person, mount or descend 2 steps even with the support of a handrail.

9

(c)

Cannot, unaided by another person, either—

9

(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.

(d)

Cannot, unaided by another person, either—

6

(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.

(e)

None of the above applies.

0

2. Standing and sitting.

2(a)

Cannot move between one seated position and another seated position which are located next to one another without receiving physical assistance from another person.

15

(b)

Cannot, for the majority of the time, remain at a work station:

9

(i)

standing unassisted by another person (even if free to move around),

(ii)

sitting (even in an adjustable chair); or

(iii)

a combination of paragraphs (i) and (ii),

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

(c)

Cannot, for the majority of the time, remain at a work station—

6

(i)

standing unassisted by another person (even if free to move around),

(ii)

sitting (even in an adjustable chair); or

(iii)

a combination of paragraphs (i) and (ii),

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

(d)

None of the above applies.

0

3. Reaching.

3(a)

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

15

(b)

Cannot raise either arm to top of head as if to put on a hat.

9

(c)

Cannot raise either arm above head height as if to reach for something.

6

(d)

None of the above applies.

0

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

4(a)

Cannot pick up and move a 0.5 litre carton full of liquid.

15

(b)

Cannot pick up and move a one litre carton full of liquid.

9

(c)

Cannot transfer a light but bulky object such as an empty cardboard box.

6

(d)

None of the above applies.

0

5. Manual dexterity.

5(a)

Cannot press a button (such as a telephone keypad) with either hand or cannot turn the pages of a book with either hand.

15

(b)

Cannot pick up a £1 coin or equivalent with either hand.

15

(c)

Cannot use a pen or pencil to make a meaningful mark with either hand.

9

(d)

Cannot single-handedly use a suitable keyboard or mouse.

9

(e)

None of the above applies.

0

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

6(a)

Cannot convey a simple message, such as the presence of a hazard.

15

(b)

Has significant difficulty conveying a simple message to strangers.

15

(c)

Has some difficulty conveying a simple message to strangers.

6

(d)

None of the above applies.

0

7. Understanding communication by:

7(a)

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

15

(i)

verbal means (such as hearing or lip reading) alone,

(b)

Has significant difficulty understanding a simple message from a stranger due to sensory impairment.

15

(ii)

non-verbal means (such as reading 16 point print or Braille) alone, or

(c)

Has some difficulty understanding a simple message from a stranger due to sensory impairment.

6

(iii)

a combination of sub-paragraphs (i) and (ii),

(d)

None of the above applies

0

using any aid that is normally or could reasonably be used, unaided by another person.

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

8(a)

Unable to navigate around familiar surroundings, without being accompanied by another person, due to sensory impairment.

15

(b)

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

15

(c)

Unable to navigate around unfamiliar surroundings, without being accompanied by another person, due to sensory impairment.

9

(d)

None of the above applies.

0

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.

9(a)

At least once a month experiences:

15

(i)

loss of control leading to extensive evacuation to 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.

(b)

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

(c)

Neither of the above applies.

0

10. Consciousness during waking moments.

10(a)

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

15

(b)

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

6

(c)

Neither of the above applies.

0