"Employee Emergency Contact Form"

What Is an Employee Emergency Contact Form?

An Employee Emergency Contact Form is a document that contains information about an individual (or individuals) who should be contacted in case of an accident or any other traumatic event that has happened to an employee. The purpose of the form is to provide a company with emergency contact information for their employees.

Generally, the document is supposed to be filled in by an employee after they have become employed. The information can be used in any crisis situation and their employer will need to contact someone who is close with their employee. An employee emergency contact is usually a family member or a close friend (or a partner) who should be informed first if anything happens to an employee.

An Employee Emergency Contact Information template can be downloaded below. Similar to this form, an Employee Information Form is a document that is used by an employer to collect information about their workers. The purpose of the form is to provide the company with the employee's information that can be used for different purposes.

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What Should Be Included in an Employee Emergency Contact Form?

The document requires the employee to fill in their emergency contact information. Even though some employees might not feel comfortable with disclosing their personal information, it is for the benefit of both the business and the worker. There is no guarantee that an emergency situation will ever occur, that's why it is recommended to be prepared.

An Emergency Contact Form for an employee generally consists of several parts, which can include the following:

  1. Information about the employee. In the first part of the form, the employee should enter their full name, date of birth, title, and department they are working in.
  2. Contact information. In this part, the employee must designate their contact information, which includes their full current address, email, and telephone number.
  3. Primary emergency contact. Individuals use this part of the form to designate information about their main emergency contact. They should state their contact's full name, telephone number, email, full current address, and their relationship to the employee.
  4. Secondary emergency contact. The employee should state their second emergency contact and information about them. A second contact is required in case the first one is not available.
  5. Additional information. Employees can use this part for any other emergency information they want to provide their employers with, such as allergies, medication, and any/or other types of alerts.
  6. Signature. The document must be signed by an employee. This way they will state their will to share information and verify that the information presented in the application is true.

An employer can add more parts to the document, depending on the types of emergencies they would like to cover. Or they can structure it in a different way to make it easier to use them. In case of any changes connected with their emergency contacts (address, telephone number, etc.), an employee should renew their Employee Emergency Contact Form. The form should always stay updated for the sake of the appearance of any crisis situation. Some employers require their staff to renew their information on a regular basis (for example, annually) but it can depend on the employee's place of work.


Related Forms and Templates:

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Employee Emergency Contact Form
_______________________________
_______________________________
Employee Name
Email Address
_____________________________________________________________________
_____________________________________________________________________
Address (Street Address, City, State, ZIP Code)
_______________________________
_______________________________
Home Phone Number
Cell Phone Number
In the event of an emergency, please list the names and telephone numbers of two
individuals you would like us to contact:
First Emergency Contact
_______________________________
_______________________________
First Emergency Contact Name
Email Address
_____________________________________________________________________
_____________________________________________________________________
Address (Street Address, City, State, ZIP Code)
_______________________________
_______________________________
Work Phone Number
Cell Phone Number
Second Emergency Contact
_______________________________
_______________________________
Second Emergency Contact Name
Email Address
_____________________________________________________________________
_____________________________________________________________________
Address (Street Address, City, State, ZIP Code)
_______________________________
_______________________________
Work Phone Number
Cell Phone Number
© ​
T EMPLATEROLLER.COM
Employee Emergency Contact Form
_______________________________
_______________________________
Employee Name
Email Address
_____________________________________________________________________
_____________________________________________________________________
Address (Street Address, City, State, ZIP Code)
_______________________________
_______________________________
Home Phone Number
Cell Phone Number
In the event of an emergency, please list the names and telephone numbers of two
individuals you would like us to contact:
First Emergency Contact
_______________________________
_______________________________
First Emergency Contact Name
Email Address
_____________________________________________________________________
_____________________________________________________________________
Address (Street Address, City, State, ZIP Code)
_______________________________
_______________________________
Work Phone Number
Cell Phone Number
Second Emergency Contact
_______________________________
_______________________________
Second Emergency Contact Name
Email Address
_____________________________________________________________________
_____________________________________________________________________
Address (Street Address, City, State, ZIP Code)
_______________________________
_______________________________
Work Phone Number
Cell Phone Number
© ​
T EMPLATEROLLER.COM
Do you give us permission to transport you to the nearest medical facility should you
incur serious illness or injury during normal work hours?
☐ Yes
☐ No
If yes, please indicate the name and contact telephone number of the physician or
health care provider that you would like for us to contact:
_______________________________
_______________________________
Name
Email Address
_____________________________________________________________________
_____________________________________________________________________
Address (Street Address, City, State, ZIP Code)
_______________________________
_______________________________
Work Phone Number
Cell Phone Number
© ​
T EMPLATEROLLER.COM
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