Declaration of Occupational Disease - Public Service (Form)

Ministry of Public Service

Form declaration of an occupational disease intended for the official holding or probationary to be transmitted to your HRD within 2 years next:

  • The date of 1re medical finding of your disease
  • Or the date on which you were informed by a medical certificate of possible link between your illness and your professional activity
  • Or, in the case of amendments to the tables of occupational diseasesHowever, if you already have a disease corresponding to these tables, the effective date of these amendments.

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.

Warning  

The form is available at the bottom of the page.

Go to the online administrative form

Verified 02 August 2024 - Directorate for Legal and Administrative Information (Prime Minister)

For details, please use the practical information sheets :

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