Application for support from Occupational Health & Safety and Environmental Service

* Mandatory field

This is a request for support from an occupational health physician, occupational health support worker or occupational social worker.

An occupational health support worker from the Department of Occupational Health and Safety and Environmental Service will review your request. The Front Office will then schedule a consultation with one of our professionals.

Formulate your request for help as comprehensively as possible without sharing any medical information, so that we can quickly schedule an appointment for you with the right professional.

I am an

Employee

Executive

First name and surname executive

Phone number executive

Email address executive

First name and surname employee

E-mailadres medewerker

Phone number

Personnel number

Department

Reasons for application

Prevention

Guidance during absence from work

What is your question?