Declaration of an occupational accident within the private sector (form in Dutch/French)

Print the declaration form and fill it in thoroughly.

If you have difficulties filling in the declaration form, your trade union or our social controllers can help you in our Brussels office. They are available on Monday and Friday.

The legal form hereunder is not compatible with a screen reader. Therefore, please find an alternative text version (txt - 31 KB).

Please carefully read the GDPR appendix (96,02 KB) that informs you about the use of your personal information by Fedris and about your rights regarding those data.

If you print this form for another person, also print the GDPR appendix so that they are informed of their rights.

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PDF icon declaration_fr_nl_0.pdf254.02 KB