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Home Business Employee Emergency Contact Form

Employee Emergency Contact Form Template

Document the emergency contact details of an employee.

Published April 25, 2023 | Legally reviewed by Brooke Davis

If one of your employees is injured while on the job or finds themselves in any other type of emergency, it can be natural to call someone close to them for help. However, as an employer, you can’t just do that without first referring to the employee’s preferences that they provided on an employee emergency contact form.

Table of Contents
  • What Is an Employee Emergency Contact Form?
  • When to Use an Employee Emergency Contact Form
  • What to Include in an Emergency Contact Form
  • How to Write an Emergency Contact Form
  • Emergency Contact Form Example
  • Emergency Contact Form Sample

What Is an Employee Emergency Contact Form?

An employee emergency contact form is a document that includes the names and contact information of two or more of an employee’s closest friends, family members, or other loved ones. It is to be referred to by the employer if the employee finds themselves in an accident or otherwise injured while working.

When to Use an Employee Emergency Contact Form

For example, say an employee is injured while at work to the point where they must go to the hospital. They may be incapacitated and unable to let anyone close to them know personally. In that case, it would be up to the employer to make those phone calls, but you can only do so to those specified on the form the employee previously consented to.

What to Include in an Emergency Contact Form

In addition to including contact information for the employee in question, an employee emergency contact form should also include details for the following:

  • The primary emergency contact
  • The secondary emergency contact
  • Contact information for the employee’s primary care provider
  • Information about any allergies or medical conditions they might have

Note that any provided contact information should include not just someone’s full name and a brief overview of the relationship with the employee but also their address, cellphone number, and work phone numbers.

How to Write an Emergency Contact Form

To make an employee emergency contact form as effective as possible, there are a few key steps to follow:

Step 1 – Contact Information

By far, the most crucial section is contact information about the employee, their primary and secondary emergency contacts, and even their doctor. Spaces should be provided so the employee can give someone’s name, a brief overview of their relationship (for example, spouse), address, home phone numbers, and work phone numbers. All of this will need to be quickly referred to by the employer should an emergency arise.

Step 2 – The Voluntary Disclosures

At that point, a section should be offered that allows the employee to disclose any emergency medical information that may be relevant voluntarily. This can include food allergies or any medical conditions they might have. This will assist professionals in responding adequately to a medical emergency.

Finally, the employee can sign and date the form in a brief section at the bottom, allowing the employer to refer to its information when needed.

Selecting an Emergency Contact

When employees select an emergency contact, they should do so based on: A) their relationship with this person; and B) that person’s overall reliability. Naturally, any spouse or parent makes an ideal emergency contact as they would likely respond quickly when needed. Close friends can also make great emergency contacts, provided they can handle the responsibility should the employee get injured or be involved in an accident while at work.

Emergency Contact Form Example

This emergency contact form example shows a document ready for a specific employee:

Employee Emergency Contact Form example

Emergency Contact Form Sample

Below, you can download an emergency contact form template in PDF or Word format:

Employee Emergency Contact Form screenshot

Download PDF
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Related Employment Documents

  • Work From Home Policy: Set rules and guidelines for your employees working from home with a work from home policy.
  • Employee Vaccination Policy: Use our employee vaccination policy template if you require your employees to be vaccinated.
  • Employment Contract: Use this document to hire an employee for your business, and define details like wages and working hours.
Employee Emergency Contact Form screenshot Preview PDF

Employee Emergency Contact Form

Create your Employee Emergency Contact Form today!

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