Employee Emergency Contact Form printable pdf download

Employee Emergency Contact Form

EMERGENCY CONTACT FORM

EMPLOYEE INFORMATION:

NAME: _________________________________________________________________

HOME ADDRESS: _______________________________________________________

CITY: _____________________________________

STATE: ___________________________________

PHONE NUMBERS:

HOME: ___________________

CELLULAR: _______________

Please contact the following in the event of an emergency:

PRIMARY CONTACT: ___________________________________________________

RELATIONSHIP: ________________________________________________________

ADDRESS: _____________________________________________________________

PHONE: WORK ___________________CELL ______________HOME_____________

SECONDARY CONTACT: ________________________________________________

RELATIONSHIP: ________________________________________________________

ADDRESS: _____________________________________________________________

PHONE: WORK ___________________CELL ______________HOME_____________

SIGNATURE:__________________________________________DATE:____________

The Emergency Contact Form is maintained in the employee’s official personnel

file. Employees are responsible for updating their emergency contact information.

For Emergency Use Only

Employee Emergency Contact Form