What Is an Employee Emergency Contact Form?
An employee emergency contact form is a document you give to your employees so they can supply emergency contact details. It also lets them disclose information about their allergies or conditions. When you make it part of your onboarding checklist, you can promote safety and morale from their hiring date.
Once the employee fills out this form, they’ll return it to you. Be sure to store it for safekeeping in your company’s HR records. If the employee shows symptoms of a health problem or needs to go to the hospital, you can contact the individuals listed on their form. These emergency contacts can provide support and make medical decisions if they have the proper authority.
Call 911 First
Always seek medical aid first. When the employee is in stable condition, reach out to their contacts.
Fill out the Legal Templates form to ensure you’re prepared and took the right steps. We let you input your company name to make it clear that the employee authorizes you to contact the listed individuals. You can create this form for a specific employee in advance or print out blank copies. In any case, the employee will fill out their information themselves, ensuring you can only contact trusted contacts.
What to Ask for in an Emergency Contact Form
When offering employees a simple emergency contact form, it’s important to request the right information.
1. Employee Information
If you’re preparing the Legal Templates form in advance, you can input the employee’s name, job title, and department. If you want to hand out these forms to employees on an as-needed basis, you can leave this section blank.
The employee can fill out their name and other information, such as their address and phone number. This information helps you clearly identify who the staff emergency contact form is for. Our template features the employee’s name at the top of the page, allowing you to easily look through your records and pull out the one you need.
2. Emergency Contacts
Ask the employee to list primary and secondary contacts. By listing a secondary contact, they can give you someone else to contact in case the first one is unresponsive or unavailable to help.
Encourage employees to choose their emergency contacts based on the person’s overall reliability and ability to handle high-pressure situations. They should also consider their relationship with the person. Employees may consider their spouses, close friends, and adult children when selecting emergency contacts.
Was an Employee Involved in a Workplace Accident?
Fill out a workplace incident report form to document an accident.
3. Preferred Healthcare Provider
Have the employee write down the name of their preferred doctor or clinic. Leave a space for them to give the phone number and address, so you can contact the provider if there’s a medical emergency.
In an emergency, it might not always be possible to use their chosen doctor. However, keeping their preference on file shows that you care and respect what they want.
4. Allergies & Medical Conditions
This form isn’t limited to emergency contact information. You can also let employees list their medical information, including known medical conditions or allergies. They can even add their medications, blood type, and specific medical instructions. Our emergency contact sheet leaves space for these details but clarifies that their disclosure is voluntary, preventing legal issues.
5. Authorization Statement
Include a statement that authorizes the employee to share their information with you as the employer. Designate lines for them to sign their name so they can confirm that you have permission to contact the listed personnel. This statement shows that the employee gave their consent, helping you avoid legal issues if you need to use the information in an emergency.
Employee Emergency Contact Form Sample
View an example of a free emergency contact form so you can see what information to request. When you’re ready, use our printable employee emergency contact form to create your own. Available to download in PDF and Word formats.
