registre premiers secours - securex

Registre premiers secours

HR InsuRance

Pourquoi un registre “premiers secours” ?Les accidents bénins doivent être enregistrés dans ce document.

Définition d’un ‘accident bénin’Il s’agit d’un accident bénin si les conditions suivantes sont remplies cumulativement:

• il n’y pas de perte de salaire; • la victime n’est pas en incapacité de travail; • l’accident a seulement occasionné des soins pour lesquels l’intervention d’un médecin n’est pas nécessaire; • les soins ont été prodigués après l’accident, uniquement sur le lieu de l’exécution du contrat de travail.

Pas d’obligation de déclaration d’accident du travail, mais obligation d’enregistrement Le travailleur qui pratique une intervention dans le cadre des premiers secours doit indiquer les éléments suivant dans un registre que tient l’employeur:

• son nom; • le nom de la victime; • l’endroit, la date, l’heure, la description et les circonstances de l’accident; • la nature, la date et l’heure de l’intervention; • l’identité des témoins éventuels.

L’assureur ne doit plus être mis au courant des accidents bénins.

L’obligation de déclaration subsiste en cas d’aggravation d’un accident béninEn cas d’aggravation d’un accident bénin, l’obligation de déclaration est de nouveau d’application. L’employeur doit faire la déclaration dans les huit jours à compter du jour qui suit celui au cours duquel il a été informé de l’aggravation de l’accident bénin.

- 3 -

ENREGISTREMENT N° _______________

Accident ou malaise du Date ______________________________ Heure _______________________________

Nom de la victime

Accident / Malaise

Endroit ___________________________________________________________________________

___________________________________________________________________________

Description ___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

Circonstances ___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

Intervention du Date ______________________________ Heure _______________________________

Nom du secouriste

Intervention

Nature des lésion ___________________________________________________________________________

___________________________________________________________________________

Type de soins donnés ___________________________________________________________________________

___________________________________________________________________________

Témoins éventuels

- 4 -

ENREGISTREMENT N° _______________

Accident ou malaise du Date ______________________________ Heure _______________________________

Nom de la victime

Accident / Malaise

Endroit ___________________________________________________________________________

___________________________________________________________________________

Description ___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

Circonstances ___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

Intervention du Date ______________________________ Heure _______________________________

Nom du secouriste

Intervention

Nature des lésion ___________________________________________________________________________

___________________________________________________________________________

Type de soins donnés ___________________________________________________________________________

___________________________________________________________________________

Témoins éventuels

- 5 -

ENREGISTREMENT N° _______________

Accident ou malaise du Date ______________________________ Heure _______________________________

Nom de la victime

Accident / Malaise

Endroit ___________________________________________________________________________

___________________________________________________________________________

Description ___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

Circonstances ___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

Intervention du Date ______________________________ Heure _______________________________

Nom du secouriste

Intervention

Nature des lésion ___________________________________________________________________________

___________________________________________________________________________

Type de soins donnés ___________________________________________________________________________

___________________________________________________________________________

Témoins éventuels

- 6 -

ENREGISTREMENT N° _______________

Accident ou malaise du Date ______________________________ Heure _______________________________

Nom de la victime

Accident / Malaise

Endroit ___________________________________________________________________________

___________________________________________________________________________

Description ___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

Circonstances ___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

Intervention du Date ______________________________ Heure _______________________________

Nom du secouriste

Intervention

Nature des lésion ___________________________________________________________________________

___________________________________________________________________________

Type de soins donnés ___________________________________________________________________________

___________________________________________________________________________

Témoins éventuels

- 7 -

ENREGISTREMENT N° _______________

Accident ou malaise du Date ______________________________ Heure _______________________________

Nom de la victime

Accident / Malaise

Endroit ___________________________________________________________________________

___________________________________________________________________________

Description ___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

Circonstances ___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

Intervention du Date ______________________________ Heure _______________________________

Nom du secouriste

Intervention

Nature des lésion ___________________________________________________________________________

___________________________________________________________________________

Type de soins donnés ___________________________________________________________________________

___________________________________________________________________________

Témoins éventuels

- 8 -

ENREGISTREMENT N° _______________

Accident ou malaise du Date ______________________________ Heure _______________________________

Nom de la victime

Accident / Malaise

Endroit ___________________________________________________________________________

___________________________________________________________________________

Description ___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

Circonstances ___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

Intervention du Date ______________________________ Heure _______________________________

Nom du secouriste

Intervention

Nature des lésion ___________________________________________________________________________

___________________________________________________________________________

Type de soins donnés ___________________________________________________________________________

___________________________________________________________________________

Témoins éventuels

- 9 -

ENREGISTREMENT N° _______________

Accident ou malaise du Date ______________________________ Heure _______________________________

Nom de la victime

Accident / Malaise

Endroit ___________________________________________________________________________

___________________________________________________________________________

Description ___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

Circonstances ___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

Intervention du Date ______________________________ Heure _______________________________

Nom du secouriste

Intervention

Nature des lésion ___________________________________________________________________________

___________________________________________________________________________

Type de soins donnés ___________________________________________________________________________

___________________________________________________________________________

Témoins éventuels

- 10 -

ENREGISTREMENT N° _______________

Accident ou malaise du Date ______________________________ Heure _______________________________

Nom de la victime

Accident / Malaise

Endroit ___________________________________________________________________________

___________________________________________________________________________

Description ___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

Circonstances ___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

Intervention du Date ______________________________ Heure _______________________________

Nom du secouriste

Intervention

Nature des lésion ___________________________________________________________________________

___________________________________________________________________________

Type de soins donnés ___________________________________________________________________________

___________________________________________________________________________

Témoins éventuels

- 11 -

ENREGISTREMENT N° _______________

Accident ou malaise du Date ______________________________ Heure _______________________________

Nom de la victime

Accident / Malaise

Endroit ___________________________________________________________________________

___________________________________________________________________________

Description ___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

Circonstances ___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

Intervention du Date ______________________________ Heure _______________________________

Nom du secouriste

Intervention

Nature des lésion ___________________________________________________________________________

___________________________________________________________________________

Type de soins donnés ___________________________________________________________________________

___________________________________________________________________________

Témoins éventuels

- 12 -

ENREGISTREMENT N° _______________

Accident ou malaise du Date ______________________________ Heure _______________________________

Nom de la victime

Accident / Malaise

Endroit ___________________________________________________________________________

___________________________________________________________________________

Description ___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

Circonstances ___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

Intervention du Date ______________________________ Heure _______________________________

Nom du secouriste

Intervention

Nature des lésion ___________________________________________________________________________

___________________________________________________________________________

Type de soins donnés ___________________________________________________________________________

___________________________________________________________________________

Témoins éventuels

- 13 -

ENREGISTREMENT N° _______________

Accident ou malaise du Date ______________________________ Heure _______________________________

Nom de la victime

Accident / Malaise

Endroit ___________________________________________________________________________

___________________________________________________________________________

Description ___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

Circonstances ___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

Intervention du Date ______________________________ Heure _______________________________

Nom du secouriste

Intervention

Nature des lésion ___________________________________________________________________________

___________________________________________________________________________

Type de soins donnés ___________________________________________________________________________

___________________________________________________________________________

Témoins éventuels

- 14 -

ENREGISTREMENT N° _______________

Accident ou malaise du Date ______________________________ Heure _______________________________

Nom de la victime

Accident / Malaise

Endroit ___________________________________________________________________________

___________________________________________________________________________

Description ___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

Circonstances ___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

Intervention du Date ______________________________ Heure _______________________________

Nom du secouriste

Intervention

Nature des lésion ___________________________________________________________________________

___________________________________________________________________________

Type de soins donnés ___________________________________________________________________________

___________________________________________________________________________

Témoins éventuels

- 15 -

ENREGISTREMENT N° _______________

Accident ou malaise du Date ______________________________ Heure _______________________________

Nom de la victime

Accident / Malaise

Endroit ___________________________________________________________________________

___________________________________________________________________________

Description ___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

Circonstances ___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

Intervention du Date ______________________________ Heure _______________________________

Nom du secouriste

Intervention

Nature des lésion ___________________________________________________________________________

___________________________________________________________________________

Type de soins donnés ___________________________________________________________________________

___________________________________________________________________________

Témoins éventuels

- 16 -

ENREGISTREMENT N° _______________

Accident ou malaise du Date ______________________________ Heure _______________________________

Nom de la victime

Accident / Malaise

Endroit ___________________________________________________________________________

___________________________________________________________________________

Description ___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

Circonstances ___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

Intervention du Date ______________________________ Heure _______________________________

Nom du secouriste

Intervention

Nature des lésion ___________________________________________________________________________

___________________________________________________________________________

Type de soins donnés ___________________________________________________________________________

___________________________________________________________________________

Témoins éventuels

- 17 -

ENREGISTREMENT N° _______________

Accident ou malaise du Date ______________________________ Heure _______________________________

Nom de la victime

Accident / Malaise

Endroit ___________________________________________________________________________

___________________________________________________________________________

Description ___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

Circonstances ___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

Intervention du Date ______________________________ Heure _______________________________

Nom du secouriste

Intervention

Nature des lésion ___________________________________________________________________________

___________________________________________________________________________

Type de soins donnés ___________________________________________________________________________

___________________________________________________________________________

Témoins éventuels

- 18 -

ENREGISTREMENT N° _______________

Accident ou malaise du Date ______________________________ Heure _______________________________

Nom de la victime

Accident / Malaise

Endroit ___________________________________________________________________________

___________________________________________________________________________

Description ___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

Circonstances ___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

Intervention du Date ______________________________ Heure _______________________________

Nom du secouriste

Intervention

Nature des lésion ___________________________________________________________________________

___________________________________________________________________________

Type de soins donnés ___________________________________________________________________________

___________________________________________________________________________

Témoins éventuels

- 19 -

ENREGISTREMENT N° _______________

Accident ou malaise du Date ______________________________ Heure _______________________________

Nom de la victime

Accident / Malaise

Endroit ___________________________________________________________________________

___________________________________________________________________________

Description ___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

Circonstances ___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

Intervention du Date ______________________________ Heure _______________________________

Nom du secouriste

Intervention

Nature des lésion ___________________________________________________________________________

___________________________________________________________________________

Type de soins donnés ___________________________________________________________________________

___________________________________________________________________________

Témoins éventuels

- 20 -

ENREGISTREMENT N° _______________

Accident ou malaise du Date ______________________________ Heure _______________________________

Nom de la victime

Accident / Malaise

Endroit ___________________________________________________________________________

___________________________________________________________________________

Description ___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

Circonstances ___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

Intervention du Date ______________________________ Heure _______________________________

Nom du secouriste

Intervention

Nature des lésion ___________________________________________________________________________

___________________________________________________________________________

Type de soins donnés ___________________________________________________________________________

___________________________________________________________________________

Témoins éventuels

- 21 -

ENREGISTREMENT N° _______________

Accident ou malaise du Date ______________________________ Heure _______________________________

Nom de la victime

Accident / Malaise

Endroit ___________________________________________________________________________

___________________________________________________________________________

Description ___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

Circonstances ___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

Intervention du Date ______________________________ Heure _______________________________

Nom du secouriste

Intervention

Nature des lésion ___________________________________________________________________________

___________________________________________________________________________

Type de soins donnés ___________________________________________________________________________

___________________________________________________________________________

Témoins éventuels

- 22 -

ENREGISTREMENT N° _______________

Accident ou malaise du Date ______________________________ Heure _______________________________

Nom de la victime

Accident / Malaise

Endroit ___________________________________________________________________________

___________________________________________________________________________

Description ___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

Circonstances ___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

Intervention du Date ______________________________ Heure _______________________________

Nom du secouriste

Intervention

Nature des lésion ___________________________________________________________________________

___________________________________________________________________________

Type de soins donnés ___________________________________________________________________________

___________________________________________________________________________

Témoins éventuels

- 23 -

ENREGISTREMENT N° _______________

Accident ou malaise du Date ______________________________ Heure _______________________________

Nom de la victime

Accident / Malaise

Endroit ___________________________________________________________________________

___________________________________________________________________________

Description ___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

Circonstances ___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

Intervention du Date ______________________________ Heure _______________________________

Nom du secouriste

Intervention

Nature des lésion ___________________________________________________________________________

___________________________________________________________________________

Type de soins donnés ___________________________________________________________________________

___________________________________________________________________________

Témoins éventuels

- 24 -

ENREGISTREMENT N° _______________

Accident ou malaise du Date ______________________________ Heure _______________________________

Nom de la victime

Accident / Malaise

Endroit ___________________________________________________________________________

___________________________________________________________________________

Description ___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

Circonstances ___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

Intervention du Date ______________________________ Heure _______________________________

Nom du secouriste

Intervention

Nature des lésion ___________________________________________________________________________

___________________________________________________________________________

Type de soins donnés ___________________________________________________________________________

___________________________________________________________________________

Témoins éventuels

- 25 -

ENREGISTREMENT N° _______________

Accident ou malaise du Date ______________________________ Heure _______________________________

Nom de la victime

Accident / Malaise

Endroit ___________________________________________________________________________

___________________________________________________________________________

Description ___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

Circonstances ___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

Intervention du Date ______________________________ Heure _______________________________

Nom du secouriste

Intervention

Nature des lésion ___________________________________________________________________________

___________________________________________________________________________

Type de soins donnés ___________________________________________________________________________

___________________________________________________________________________

Témoins éventuels

- 26 -

ENREGISTREMENT N° _______________

Accident ou malaise du Date ______________________________ Heure _______________________________

Nom de la victime

Accident / Malaise

Endroit ___________________________________________________________________________

___________________________________________________________________________

Description ___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

Circonstances ___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

Intervention du Date ______________________________ Heure _______________________________

Nom du secouriste

Intervention

Nature des lésion ___________________________________________________________________________

___________________________________________________________________________

Type de soins donnés ___________________________________________________________________________

___________________________________________________________________________

Témoins éventuels

- 27 -

ENREGISTREMENT N° _______________

Accident ou malaise du Date ______________________________ Heure _______________________________

Nom de la victime

Accident / Malaise

Endroit ___________________________________________________________________________

___________________________________________________________________________

Description ___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

Circonstances ___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

Intervention du Date ______________________________ Heure _______________________________

Nom du secouriste

Intervention

Nature des lésion ___________________________________________________________________________

___________________________________________________________________________

Type de soins donnés ___________________________________________________________________________

___________________________________________________________________________

Témoins éventuels

- 28 -

ENREGISTREMENT N° _______________

Accident ou malaise du Date ______________________________ Heure _______________________________

Nom de la victime

Accident / Malaise

Endroit ___________________________________________________________________________

___________________________________________________________________________

Description ___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

Circonstances ___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

Intervention du Date ______________________________ Heure _______________________________

Nom du secouriste

Intervention

Nature des lésion ___________________________________________________________________________

___________________________________________________________________________

Type de soins donnés ___________________________________________________________________________

___________________________________________________________________________

Témoins éventuels

- 29 -

ENREGISTREMENT N° _______________

Accident ou malaise du Date ______________________________ Heure _______________________________

Nom de la victime

Accident / Malaise

Endroit ___________________________________________________________________________

___________________________________________________________________________

Description ___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

Circonstances ___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

Intervention du Date ______________________________ Heure _______________________________

Nom du secouriste

Intervention

Nature des lésion ___________________________________________________________________________

___________________________________________________________________________

Type de soins donnés ___________________________________________________________________________

___________________________________________________________________________

Témoins éventuels

- 30 -

ENREGISTREMENT N° _______________

Accident ou malaise du Date ______________________________ Heure _______________________________

Nom de la victime

Accident / Malaise

Endroit ___________________________________________________________________________

___________________________________________________________________________

Description ___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

Circonstances ___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

Intervention du Date ______________________________ Heure _______________________________

Nom du secouriste

Intervention

Nature des lésion ___________________________________________________________________________

___________________________________________________________________________

Type de soins donnés ___________________________________________________________________________

___________________________________________________________________________

Témoins éventuels

CF00

20 -

2014

0512

www.securex.be - insurance@securex.be - 09 280 41 70