emergency contact form template

Emergency Contact Form

bizzlibrary template file type image
.docx (0.02 MB)

Every company should have an employee emergency contact form. It is a form that keeps emergency contact information for each employee. It is usually filled at employment and used only in special situations such as a severe workplace injury, severe medical conditions, and other emergencies.

What information should you add to your Emergency contact form?

When generating an emergency contact form, consider adding the following information:

  • Company information; First things first, your business information should be the top entry on your list. This should include your company name, address, location, and phone number. While you may think you’ll remember these details, in a moment of panic you could forget valuable information, so it’s better to be safe. That way, when you’re speaking with emergency services, you have all the details right in front of you.
  • Facility manager; If there’s a problem with your building, the knowledge and expertise of your facility manager, building owner, or landlord may come in handy. They’ll know the ins and outs of the property and may be able to reverse an urgent situation. It’s important to include a few forms of contact info, if possible, so you have the best chance of reaching them right away.
  • Employee information; Your list should also include contact info for your employees and their designated emergency contacts. This is important for two reasons. First, your employees will need to know if something goes wrong with the business. Second, if the emergency involves one of your employees, you’ll need to get in touch with their emergency contacts. That’s why your list should include a phone number (and email address) for all employees, as well as an emergency contact for each employee.
  • Emergency service numbers; Everyone knows to call 911 if a disaster occurs, but some other emergency services deserve a spot on your contact list, too. These could include poison control, animal control, your alarm system company, and any other industry-specific services you think you might need if things do go wrong.
  • Insurance information; If your business experiences a loss, you’ll need to contact your insurer as soon as possible. That’s why your emergency contact list should include the name of your insurance company, your policy number, and the direct number to their claims team. That way, you can get in touch with your insurer quickly, begin the claims process faster, and get your business up and running again as soon as possible.

Emergency Contact Form:

  • Name 
  • Department
  • Personal Contact Info:
  • Home Address
  • Emergency Contact Info:
  • Relationship
  • Address
  • City, State, ZIP
  • Home Telephone 
  • Cell 
  • Work Telephone 
  • Employer
  • Medical Contact Info:
  • Doctor Name
  • Dentist Name
  • Phone #
  • I have voluntarily provided the above contact information and authorized the person and its representatives to contact any of the above on my behalf in the event of an emergency.
  • Employee Signature 
  • Date

After downloading this form and filling in the blanks, you can easily customize the style, typography, details, and appearance of your Emergency contact form. If this ain't the right document that you are looking for, then certainly take a look at the other letters that Bizzlibrary.com has to offer. We have many letters ranging from cover letters to business letters and thank you notes.

The content is for informational purposes only, you should not construe any such information or other material as legal, tax, investment, financial, or other advice. Nothing contained this site constitutes a solicitation, recommendation, endorsement, or offer by Bizzlibrary or any third party service provider to buy or sell any securities or other financial instruments in this or in any other jurisdiction in which such solicitation or offer would be unlawful under the securities laws of such jurisdiction.


Shanita Peters(8/10/2021) - NZL

Glad to find this file

Harriette Ball(8/10/2021) - NZL


Alethia Johnson(8/10/2021) - DEU

Excellent value document

Gladis Mayer(8/10/2021) - USA

actually this file is really what I was looking for

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