Accident at work Occupational Disease or Occupational Disease Sheet (Specimen) (Form 11383*02)

National Health Insurance Fund (Cnam) - Cerfa n° 11383*02
Autre numéro : S6201c

Please note that this version is a specimen (supplied) only for your information).

Accident at work For your application, the original form is given to you by the employer in case of a medical treatment or by the CPAM or the MSA when an occupational disease is declared.

Go to the online administrative form

Verified 26 October 2021 - Directorate for Legal and Administrative Information (Prime Minister)

Contact the entity in charge of this form

For details, please use the practical information sheets :

J'ai réalisé une démarche administrative

Je donne mon avis sur Services Publics +. L'administration concernée me répondra.

Je donne mon avis