Employee Emergency Contact Form
Download a blank fillable Employee Emergency Contact Form in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Employee Emergency Contact Form with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1Employee Emergency Contact Form
Please return this form to the
Office of Human Resources
Name: _______________________________________________________________________
Home Address: ________________________________________________________________
City: __________________________________ State: ________
Zip: _______________
Home Phone #: _________________________ Cell Phone #: ___________________________
E-Mail Address: _______________________________________________________________
In the event of an emergency, please list the names and telephone numbers of two
individuals you would like us to contact:
Emergency Contact #1:
Name: ______________________________________________________________________
Home Address: _______________________________________________________________
City: __________________________________ State: ________
Zip: _______________
Work Phone #: _________________________ Cell Phone #: ___________________________
Emergency Contact #2
Name: ______________________________________________________________________
Home Address: _______________________________________________________________
City: __________________________________ State: ________
Zip: _______________
Work Phone #: _________________________ Cell Phone #: ___________________________
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: ______________________________________________________________________
Home Address: _______________________________________________________________
City: __________________________________ State: ________
Zip: _______________
Work Phone #: _________________________ Cell Phone #: ___________________________
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Business