Incident note

Fill in the following fields with your data in order to complete the incident note.

Insured person

Personal data

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Accident report

Accident details

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Until when did the insuree work in the company before the accident occured?

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Accident information

Characters remaining:

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Incapacity to work

Incapacity to work



   
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Work resumption


   
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Injury

Main injury

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Other injury 1

   
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Other injury 2

   
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Treatment

Initial treatment by doctor/hospital


   
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Subsequent treatment by doctor/hospital


   
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Finish

  
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The information that you submit in this tool, as well as any additional or follow-up information that you may submit in connection with this claim, will be used by the responsible HR functions of Credit Suisse AG in Switzerland and will be transferred to and processed Credit Suisse AG’s accident insurer, AXA Winterthur in Switzerland, together with additional relevant employment information and personal details about you provided by Credit Suisse AG necessary to administer the claim. Accordingly, by submitting this claim electronically, you hereby expressly authorize and agree to the transfer, processing and disclosure of your information, in electronic or physical form, as described above by and between Credit Suisse AG and AXA Winterthur, for the purposes of processing your claim. Your information will be retained by Credit Suisse AG and AXA Winterthur for as long as required for these purposes, or until no longer required to be retained under relevant law or Credit Suisse policies.

For questions on the accident report, contact

- For internal Email requests:
   MyHR Portal
- For external Email requests:
   askhr.schweiz@hr.credit-suisse.com

Version: 22200