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.
The primary purpose of an employee emergency contact form is to gather and keep important contact information for employees in an emergency.
What to Include
To write an emergency contact, you should include all the essential information that would be needed in case of an emergency.
1. Personal Information:
- Full name of the individual for whom the form is being filled out
- Date of birth
- Gender
- Home address
- Email address
- Phone numbers (home, mobile, work)
- Information about the company and manager
2. Primary & Secondary Emergency Contact:
- Full name of the primary emergency contact
- Relationship to the individual
- Phone numbers (home, mobile, work)
- Email address
- Address (if different from an individual)
3. Medical Information:
- Any known medical conditions or allergies of the individual
- Current medications being taken
- Blood type (if known)
- Specific medical instructions or preferences, if any
4. Insurance Information:
- Health insurance provider
- Policy number
- Contact information for the insurance company
5. Additional Emergency Contacts:
- Any other individuals who should be contacted in case the primary and secondary contacts are unavailable
- Their full names, relationships to the individual, and contact information
6. Doctor and Healthcare Provider Information:
- Name of the primary care physician
- Contact information for the doctor or healthcare provider
7. Other Important Contacts:
- Other important contacts, such as close friends, neighbors, or caregivers, should be notified in case of an emergency
- Their full names, relationships to the individual, and contact information
8. Special Instructions:
- Any special instructions or information that would be helpful for emergency responders or healthcare professionals, such as specific medical procedures or equipment needed
Keep the emergency contact form updated and easily accessible in an emergency. Regularly review and revise the information significantly if any contact details or medical conditions change.
Choosing an Emergency Contact
When employees select an emergency contact, they should do so based on the following:
- their relationship with this person; and
- 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.
Sample
Below, you can download an emergency contact form template in PDF or Word format:
