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Accueil particuliers  > Services en ligne et formulaires  > Déclaration d'accident de service - accident de trajet - Fonction publique

Modèle de document

Déclaration d'accident de service - accident de trajet - Fonction publique (Modèle de document)

Vérifié le 23 septembre 2022 - Direction de l'information légale et administrative (Première ministre)

Modèle de formulaire de déclaration d'accident de travail ou d'accident de trajet, destiné au fonctionnaire titulaire ou stagiaire, à transmettre à votre DRH dans les 15 jours suivant la date de l'accident.

Le formulaire de déclaration doit être accompagné d'un certificat médical indiquant la nature et le siège des lésions résultant de l'accident et, éventuellement, la durée de l'incapacité de travail en découlant.

Si l'accident entraîne un arrêt de travail, vous devez transmettre cet arrêt de travail dans les 48 heures suivant son établissement.

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Ministère chargé de la fonction publique

Pour toute explication, consulter les fiches pratiques :

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