Form

Capability for work questionnaire

Only fill in this capability for work questionnaire (ESA50) if you’re asked to do so – this is not a claim form.

Documents

Capability for work questionnaire

Welsh: Holiadur gallu i weithio

Details

Find out how to claim Employment and Support Allowance

Using this form

Fill in this form only if you’ve been asked to do a Work Capability Assessment.

  1. Save a copy of the form.
  2. Open it in Adobe Acrobat Reader version XI or later.
  3. Fill it in on screen.
  4. Print it and sign it.

The form explains where to send it. If you have any questions, please contact the office that asked you to fill it in.

Alternative formats

This form is also available in Welsh, braille, large print, audio cassette or CD. If you want any of these, please call Jobcentre Plus on 0345 608 8545 and tell us which you need.

If you are having technical difficulties

Please contact the DWP online helpdesk if you are having difficulty:

  • downloading the form
  • navigating around the form
  • printing the form

DWP online helpdesk

Monday to Friday 8am to 6pm
Closed weekends and all public and bank holidays

Residents of Northern Ireland

Don’t use this form if you live in Northern Ireland. Contact the Employment and Support Allowance Centre.

Published 4 April 2013
Last updated 14 November 2018 + show all updates
  1. Revised ESA50: Capability for work questionnaire - English and Welsh.
  2. The capability for work questionnaire (ESA50) is currently unavailable. The latest version of the questionnaire will be added to this page shortly.
  3. Published updated version of the ESA50 form - English version.
  4. Updated the DWP online helpdesk contact details.
  5. Published updated English version of the ESA50 form.
  6. Published updated English and Welsh versions of the ESA50 form.
  7. published updated version of the ESA50 form.
  8. First published.