Accident report form student

All lawfully enrolled students are insured for the duration of the academic year and according to the concluded policy terms and conditions against:

Physical accidents:
- on the regular, direct way to and from Howest or any other location where an activity takes place within the framework of school activities;
- during teaching and evaluation activities;
- in all the rooms of Howest where students are present for their studies;
- during journeys and stays at home and abroad, organised by Howest and/or in the framework of exchange programmes, whether or not during holidays, from the moment of departure until the moment of return;
- during the implementation of all assignments given by Howest (including traineeships).
civil liability during an assignment within the framework of the school activity.
guarantee of goods entrusted (by third parties and on the occasion of traineeships)

If a company/traineeship location requires proof of insurance within the framework of a school assignment or a traineeship assignment, an insurance certificate can be delivered to the company/traineeship location.

Fill in the report form

Questions?

verzekeringen [at] howest.be (verzekeringen[at]howest[dot]be)
Algemene diensten
Marksesteenweg 58 - 8500 Kortrijk
056/24 12 90

Guarantees and policies

Below follows an overview of the applicable guarantees and policies.

		Civil Liability and/or legal assistance	Physical accidents to and from school or traineeship location	Physical accidents during school activity/traineeship	Travel Assistance	Material damage to own car (journey in the course of employment)
Howest student in Belgium	School activity	45.262.212	45.262.212	45.262.212	/	/
Howest student in Belgium	Unpaid traineeship	45.262.212	45.262.212	6.569.874	/	/
Howest student abroad	Study trip (incl. private)	45.262.212	45.262.212	45.262.212	45.052.701 to be applied for	/
	Study trip (incl. private) USA/Anglo-Saxon/ non-European countries	45.262.212	45.262.212	45.262.212	00.000.000 to be applied for	/
	Study (incl. private)	45.262.212	45.262.212	45.262.212	00.000.000 to be applied for	/
	Unpaid traineeship (incl. private)	45.262.212	45.262.212	6.569.874	00.000.000 to be applied for	/
	Paid traineeship (incl. private) remuneration > expense allowance	45.262.212	45.262.212	To be insured by traineeship site	00.000.000 to be applied for	/
Volunteers	In the event of a Howest activity	45.262.212	45.152.214	45.152.214	/	/

You can report physical accidents using the online form below.

The form can only be sent if all mandatory fields (marked with an *) are filled in and if a scan of the medical certificate is uploaded (see at the bottom of this form). After completing the form, click on the 'send' button.

If the student does not yet have a medical certificate in which the doctor certifies that the injuries are the result of the accident, a blank medical certificate can be downloaded. This form must be completed and signed by the attending physician.

Upon receipt of the online declaration from the student, a Howest employee reports the accident to Ethias within a reasonable period of time on the basis of the form filled in by the student and the accompanying medical certificate. The Howest employee sends additional information to the student’s Howest e-mail address regarding the settlement of the claim/file as well as a digital printout of the declaration.

General information

Campus at which the person affected is enrolled

Study department

Date and time of the accident

Date and time of reporting the accident to the student administration desk

Type of accident

Physical

Material

of a student

of an insured person (e.g. staff member, student,...)

of a third party

It concerns an accident at the traineeship company

Traineeship company

Name

Address

Postal code

City/Town/Municipality

Country

Start date traineeship

End date traineeship

Schedule of the person affected on the day of the accident

Function on the traineeship

The student

First name

Name

Language

Dutch

English

French

Other language

Address

Postal code

City/Town/Municipality

Country

Date of birth

Phone number

Identification number Social Security (= national registry number)

IBAN Bank account for refund

With which insurance company is the student insured for his/her civil liability (family insurance, car, motorcycle, etc.)?

Insurance company

Policy number

File number

The accident

Where (neighbourhood or type of place) was the person affected situated when the accident happened?

e.g. maintenance area; office; hospital; car park; sports hall; motorway; etc.

Identify the general activity (type of work) or task (in the broad sense) that the injured person was performing when the accident occurred

for example: processing products, storage, care, assistance to a person or persons, training, office work, purchase, sales, etc. or the secondary activities of these different activities, such as installation, detaching, maintenance, repair, etc.

Identify the specific activity that the injured person was performing when the accident occurred

for example: filling the machine, working with hand tools, driving a means of transport, gripping,
lifting, rolling an object, carrying a load, closing a box, walking, sitting down, etc.

And the objects involved
for example: tools, machine, equipment, materials,
objects, instruments, substances, etc.

What events deviating from the normal course of work led to the accident?

for example: electrical failure; explosion; fire; overflowing, tilting, leaking, gassing, bursting, falling or collapsing object; abnormal starting or functioning of a machine; loss of control of a means of transport or an object; slipping or falling of a person; improper action; incorrect movements; surprise; fright; assault; being assaulted; etc.

List all events AND the objects that played a part in the accident

for example: tools, machinery, equipment, materials, objects, instruments, substances, etc.

Third parties

Is there a third party involved in the accident?

Please give all information available to you regarding the other parties involved in the accident.

First name

Name

Language

Dutch

English

French

Other language

Name of the legal representative in case of a minor

Address

Postal code

Gemeente

Country

Phone

Function

Date of birth

With which insurance company is he/she insured for his/her civil liability (family insurance, car, motorcycle, etc.)?

Insurance company

Policy number

File number

Vehicle brand

License plate

Chassis number

Driver’s name

Driver’s first name

Language driver

Dutch

English

French

Other language

Address

Postal code

City/Town/Municipality

Country

Witness

Fill in the details of possible witnesses. Do not always answer "no" to the question whether there were
witnesses. We know from experience that a seemingly trivial accident can turn into a liability case after
several months. At that moment, the presence of surveillance data and witnesses is essential in order
to optimise your defence. You can fill in the details of three witnesses.

Is there a witness?

First name

Name

Language

Dutch

English

French

Other language

Address

Postal code

City/Town/Municipality

Country

Function

Reporting authority

In case an official report has been drawn up, the insurance company will usually ask for a copy of that
official report.

Have particulars been taken down by a reporting authority?

Yes

Not known

By whom?

Number of the official report

Date of the official report

Medical certificate

Has medical care been provided at the school/traineeship company?

Yes

Not known

Date and time

Capacity of the caregiver

Description of the care given

Has medical care been given by an external doctor?

Yes

Not known

If so, date and time

Name and first name of the external doctor

Address

Postal code

City/Town/Municipality

Country

Nature of the injury

Place of the injury

Do you have a medical certificate?

An accident with physical damage can only be reported if you have a medical certificate filled in by a doctor. You must attach a scanned copy of the medical certificate as an annex.

Upload medical certificate