Employee emergency contact form template

About this employee emergency contact form

If an employee is taken ill or injured at work, you need to reach someone quickly. An emergency contact form keeps two contacts, their relationship and phone numbers, and any medical information the employee chooses to share, such as allergies or conditions first aiders should know about.

Medical details are optional and should only be seen by people who need them in an emergency. Ask employees to update the form whenever their contacts change.

What’s on the employee emergency contact form

The template has 5 sections and 19 questions. Every one can be renamed, moved or deleted.

• Employee: Name; Employee ID; Department; Work phone
• Primary emergency contact: Name; Relationship; Mobile; Other phone; Address
• Secondary emergency contact: Name; Relationship; Mobile; Other phone
• Medical information (optional): Blood group (choose one: A+, A−, B+, B−, AB+, AB−, O+, O−, Don’t know); Allergies; Medical conditions first aiders should know about; Doctor’s name and phone
• Consent: Agreement: “I agree that this information may be shared with emergency services and first aiders if needed.”; Employee signature with date

Tips

• Collect it on day one, alongside the employee information form.
• Check contacts once a year; phone numbers change.
• Keep a copy where first aiders can reach it quickly.

Four ways to save it

A fillable PDF has typing boxes, tick boxes and choices built in. A printable PDF gives clean boxes and writing lines for pen and paper. The Word file can be edited further, and the HTML code adds the same questions to a website. Browse more form templates, or design a completely different layout in the custom form builder.