Employee Emergency Contact Form

Information you will need

• What’s the employee's department?
• What’s the employee's address?
• What's the employee's home phone number?
• What's the employee's cell phone number?
• What’s the name of the primary emergency contact?
• What’s the primary emergency contact's relationship to the employee?
• What’s the primary emergency contact's address?
• What's the primary emergency contact's home phone number?
• What's the primary emergency contact's cell phone number?
• What's the primary emergency contact's work phone number?
• Who's the primary emergency contact's employer?
• What’s the name of the secondary emergency contact?
• What’s the secondary emergency contact's relationship to the employee?
• What’s the secondary emergency contact's address?
• What's the secondary emergency contact's home phone number?
• What's the secondary emergency contact's cell phone number?
• What's the secondary emergency contact's work phone number?
• Who's the secondary emergency contact's employer?
• What’s the doctor's name?
• What’s the doctor's phone number?
• What’s the dentist's name?
• What’s the dentist's phone number?
• Has the employee verified the above information?
• What’s the name of the employer?

…and 1 more field in the PDF.

Completed by the employee and the employer.