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Registre premiers secours
HR Insurance Registre premiers secours 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 bénin En 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. 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 -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 - CF0020 - 20140512 www.securex.be - [email protected] - 09 280 41 70
