Employee Emergency Contact Form

Employee Emergency Contact Form

Capture an employee's emergency contact information.

An employee emergency contact form is a record containing the names and contact details of an employee's close friends, family members, or trusted individuals. It serves as a resource for employers in case of accidents or injuries during work, enabling swift and efficient communication with the employee's chosen contacts in emergencies.

The primary goal of an employee emergency contact form is to collect and maintain critical contact information for employees to ensure their safety and well-being during unforeseen situations.

Table of Contents

What is an emergency contact?

An emergency contact is a designated individual whom healthcare providers and emergency services personnel will reach out to in the event that you are in a medical or mental health crisis. This person plays a crucial role in ensuring that you receive timely and appropriate care when you are unable to communicate or make decisions for yourself during an emergency situation.

The key aspects of an emergency contact include:

  1. First Point of Contact: When you are unable to advocate for yourself due to illness, injury, or incapacitation, your emergency contact becomes the primary point of communication between you and medical professionals. They are contacted to provide vital information about your health, medical history, and any special instructions or preferences you may have.
  1. Access to Health Information: It is important that your emergency contact possesses knowledge of your health history, including any chronic conditions, allergies, medications you are taking, and past medical procedures. This information ensures that medical personnel can make informed decisions about your care, especially if you are unconscious or unable to provide details.
  1. Quick Response: Your emergency contact should be readily available and willing to respond promptly to calls from healthcare providers or emergency services. Timely responses can be critical in emergencies where swift medical intervention is necessary.
  1. Advocate for Your Needs: In addition to relaying your medical information, your emergency contact may need to make decisions on your behalf if you are unable to do so. This might involve consent for medical procedures, surgeries, or other interventions based on your previously discussed preferences or living will.
  1. Notification of Family or Loved Ones: Your emergency contact can also play a vital role in notifying your family members or loved ones about the situation, keeping them informed, and providing emotional support during a crisis.

Overall, your emergency contact is a trusted individual who ensures that your health and well-being are prioritized in times of medical emergencies when you may not be in a position to advocate for yourself. It is essential to choose this person thoughtfully and communicate your wishes and health-related information to them effectively.

What is the emergency contact information of an employee?

The emergency contact information of an employee is a crucial set of details that an employer should collect and maintain to ensure the safety and well-being of their employees. This information typically includes:

  1. Name: The full name of the employee's chosen emergency contacts. It's essential to have at least two trusted individuals listed.
  1. Contact Details: Contact information for the emergency contacts, which may include phone numbers (home, mobile, work), email addresses, and home addresses. Having multiple contact methods can be beneficial in case of urgency.
  1. Relationship to the Employee: Specify the relationship between the employee and each emergency contact. Common relationships include spouse, parent, sibling, close friend, or neighbor. Understanding the nature of this relationship can help in prioritizing who to contact in various situations.
  1. Permission to Share Medical Information: It's advisable to include a checkbox or field indicating whether the employee grants permission to share their medical information with the listed emergency contacts. This is especially important when medical decisions may need to be made on behalf of the employee.

The purpose of collecting this information is to ensure that the employer can quickly reach out to someone close to the employee if an emergency or critical situation arises during working hours. This contact can provide valuable information about the employee's medical history, allergies, existing health conditions, or any other relevant details that can aid healthcare providers in delivering appropriate care.

Additionally, having multiple emergency contacts allows for redundancy in case one person cannot be reached promptly. This ensures that the employee's well-being is prioritized, even in challenging circumstances.

Employers must handle this information with sensitivity, maintaining strict confidentiality and only using it for emergency purposes. Employees should be encouraged to update their emergency contact information as needed to keep it current and accurate.

Comprehensive Guide to Creating an Emergency Contact Form

In creating an emergency contact form, it's crucial to include all essential information that would be vital during an emergency situation. Here is a comprehensive list of what to include:

Personal Information

  • Full name of the individual the form is for.
  • Date of birth.
  • Gender.
  • Home address.
  • Email address.
  • Phone numbers (home, mobile, work).
  • Information about the company and manager.

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 the individual).

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.

Insurance Information

  • Health insurance provider.
  • Policy number.
  • Contact information for the insurance company.

Additional Emergency Contacts

  • Any other individuals to contact if the primary and secondary contacts are unavailable.
  • Their full names, relationships to the individual, and contact information.

Doctor and Healthcare Provider Information

  • Name of the primary care physician.
  • Contact information for the doctor or healthcare provider.

Other Important Contacts

  • Include other important contacts, such as close friends, neighbors, or caregivers.
  • Provide their full names, relationships to the individual, and contact information.

Special Instructions

  • Any special instructions or information that would be helpful for emergency responders or healthcare professionals.
  • This may include specific medical procedures, equipment needed, or any unique considerations.

Ensure that the emergency contact form is regularly updated and easily accessible in case of an emergency. Periodically review and revise the information, especially if there are changes in contact details or medical conditions.

Selecting the Right Emergency Contact: A Considerate Approach

When employees choose an emergency contact, it's essential to consider two primary factors:


  • The chosen person should have a close and meaningful relationship with the employee.
  • This relationship ensures that the selected contact is genuinely concerned and willing to respond swiftly in case of an emergency.


  • Reliability is paramount when designating an emergency contact.
  • The selected individual must be dependable and capable of handling the responsibility if the employee faces an injury or accident at work.

Ideal Emergency Contacts

  • Spouse or Parent: Spouses and parents are often the top choices as emergency contacts due to their close familial bonds and the likelihood of quick response.
  • Close Friends: Trusted friends can also be excellent emergency contacts, provided they are willing and capable of taking on the responsibility during emergencies.

Selecting the right emergency contact is a thoughtful decision that ensures a swift and caring response when it matters most. It's essential to discuss this choice with the selected individual to confirm their willingness to fulfill this crucial role.


What is emergency contact in forms?

Streamline the onboarding process with our employee emergency contact form. Easily collect essential emergency contact details and any pertinent medical information from employees to ensure preparedness in case of unforeseen events.

How do I make an emergency contact list for work?

Emergency Contact List for Your Business

Business Information

  • Facility Name
  • Street Address

Facility Manager

  • Name
  • Primary Contact #


  • Name

Insurance Company

  • Insurance Company Name

Emergency Numbers

  • Fire Department

Utility Companies

  • Natural Gas

Other Numbers

  • Taxi Service

Sample For Employee Emergency Contact Form

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