Declaration of Occupational Disease - Public Service (Form)

Ministry of Public Service

Occupational disease declaration form for the incumbent or trainee to be submitted to your HRD within 2 years:

• The date of the 1^re medical assessment of your disease
• Or the date on which you were informed by a medical certificate of the possible link between your illness and your professional activity
• Or, in the case of amendments to the tables of occupational diseases, where you already have a disease corresponding to those tables, the date on which those amendments came into force.

This form must be accompanied by a medical certificate indicating the nature and location of the disease and, where appropriate, the duration of the resulting incapacity for work.

If the illness results in a work stoppage, you must report the work stoppage within 48 hours of its establishment.

Go to the online administrative form

Verified 31 March 2022 - Directorate for Legal and Administrative Information (Prime Minister)