Pleasley Surgery

Chesterfield Road
NG19 7PE
01623 810249

Self Certification Sickness

As soon as you return to work after sickness, you must complete the self-certification form covering the first seven days of absence.
Your entitlement the Statutory Sick Pay will depend on the evidence of sickness you provide on the form.

Please complete the below form and hand it into the necessary department at your place of work.

View/Download Self Certification Form