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Employee Emergency Contact Form Template

Ensure Safety and Quick Response with an Employee Emergency Contact Form

When emergencies strike, quick access to employee contact information is crucial. This template is designed for HR teams and employers who want to streamline the process of collecting emergency contact details. Enjoy benefits like easy customization to fit your company's needs, effortless embedding on your website, integration with over 100 applications, and increased peace of mind knowing you have the right information ready. Start using this live template today to enhance your workplace safety measures.

Employee full name
Job title
Department or team
Work location or site
Mobile phone
Work email
Preferred contact method in an emergency
Call my mobile phone
Call my work phone
Text my mobile phone
Call my emergency contact first
Email me
No preference
Primary contact full name
Relationship to you
Please Specify:
Primary contact phone
Primary contact email (optional)
Phone type
Mobile
Home
Work
Other
Please Specify:
Secondary contact full name (optional)
Relationship to you (secondary)
Please Specify:
Secondary contact phone (optional)
Secondary contact email (optional)
Phone type (secondary)
Mobile
Home
Work
Other
Please Specify:
Medical information to share with first responders (e.g., conditions, allergies, medications)
Preferred hospital or physician (name)
I authorize my employer to share the information provided on this form with emergency responders solely for emergency purposes
Strongly disagree
Disagree
Neither
Agree
Strongly agree
Name of person completing this form
Date
I confirm the information provided is accurate to the best of my knowledge
Strongly disagree
Disagree
Neither
Agree
Strongly agree
{"name":"Employee full name", "url":"https://www.quiz-maker.com/QPREVIEW","txt":"Employee full name, Job title, Department or team","img":"https://www.quiz-maker.com/3012/images/ogquiz.png"}
Paper art illustration depicting an employee emergency contact form with a pen and decorative elements

When to use this form

Use this form during onboarding, annual HR updates, or after a role or address change to keep emergency contacts current. HR teams, managers, and safety leads benefit from fast, accurate outreach when minutes matter. Common scenarios include a warehouse injury, a sudden health issue at a desk, or an after-hours closure that requires reaching a family member. Pair it with the Staff information form to align job and shift details, and reference the Personal and family information form if you already capture household context. With clear contacts on file, you reduce delays, meet policy requirements, and support employees and their families in critical moments.

Must Ask Employee Emergency Contact Questions

  1. Who is your primary emergency contact and what is their relationship to you?

    Knowing the name and relationship helps us reach the right person quickly and explain our role. It also reduces confusion if contacts share a last name with you.

  2. What are the best phone numbers for your primary contact (mobile and alternate)?

    Multiple numbers raise the chance of a fast response, especially outside business hours. If you only need the essentials, the Quick emergency contact form keeps phone fields front and center.

  3. Who is your secondary emergency contact and how are they related to you?

    A backup contact ensures we can still reach someone if the primary is unavailable or traveling. This redundancy prevents delays when time matters.

  4. Are there any medical conditions, allergies, or medications we should share with first responders if needed?

    This optional note can guide responders and avoid harmful treatments. Keep it brief and current (for example, EpiPen, severe nut allergy, or asthma).

  5. Do you authorize us to share this information with emergency personnel and supervisors on a need-to-know basis?

    Clear consent helps us act fast while respecting privacy and policy. It also documents who may access the data during an incident.

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