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Emergency Contact & Employee Information Form
Employee information sheet with emergency contacts, medical notes, and dependants. Free download as PDF, Word, or text.
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EMERGENCY CONTACT & EMPLOYEE INFORMATION FORM
Keep current — notify HR of any changes. Store securely; this form contains sensitive personal information.
Employee information
- Full legal name: [EMPLOYEE NAME]
- Preferred name: ___________________________
- Employee ID: [ID] | Department: [DEPARTMENT] | Job title: [JOB TITLE]
- Work location: ___________________________
- Personal phone: ___________________________ | Personal email: ___________________________
- Home address: ___________________________
Emergency contact 1
- Name: ___________________________ | Relationship: ___________________________
- Phone (primary): ___________________________ | Phone (alt): ___________________________
Emergency contact 2
- Name: ___________________________ | Relationship: ___________________________
- Phone (primary): ___________________________ | Phone (alt): ___________________________
Medical information (optional — used only in an emergency)
- Allergies: ___________________________
- Current medications / conditions responders should know: ___________________________
- Physician: ___________________________ | Phone: ___________________________
- Medical insurance carrier / policy #: ___________________________
Authorization
I authorize [COMPANY NAME] to contact the persons above in case of emergency. I confirm this information is accurate and will update HR if it changes.
Employee signature: ___________________________ Date: ______________
For HR use only — Received by: ______________ Date: ______________ Filed: [ ] Yes
Showing the first section — the download includes the complete template.
Please note: General template only — not legal advice. Have employment counsel review before use, especially for state-specific requirements.
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