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

Print one of the declaration forms that you can find on one of the links below. Fill it in thoroughly.  In French and Dutch the form exists in 2 formats. You can print the declaration form of your preference.

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 form is only available in Dutch, French and German.


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.


PDF icon declaration_fr_nl_0.pdf254.02 KB