Employee Emergency Contact Form Template

Employee Emergency Contact Form Template

Every employer needs a way to reach someone if an employee has a medical emergency, is involved in a workplace accident, or cannot be contacted directly. This employee emergency contact form collects the information you need to act quickly when it matters most.

For small businesses, this form is especially important because you may not have a nurse's station or on-site safety team. Having emergency contacts, medical details, and physician information on file means you are prepared instead of scrambling.

When to Use This Form

• During new employee onboarding as part of the standard paperwork
• When conducting an annual information review and asking employees to update their records
• After an employee reports a change in marital status, household, or medical condition
• When updating your workplace safety plan or emergency response procedures

Employee Emergency Contact Form

Company Name: _______________________________________________

Date: ________ / ________ / ________

Section 1: Employee Information

Section 2: Primary Emergency Contact

Section 3: Secondary Emergency Contact

Section 4: Medical Information

This section is optional but strongly recommended. The information below can help first responders provide appropriate care in an emergency.

Section 5: Primary Care Physician

Section 6: Preferred Hospital or Medical Facility

Section 7: Additional Instructions

Use this space to note any other information you would like your employer to know in case of an emergency (for example, a preferred pharmacy, specific care instructions, or religious considerations for medical treatment).

Section 8: Employee Acknowledgment

I certify that the information provided above is accurate and complete. I understand that this information will be used solely for emergency purposes. I will notify my employer promptly if any of these details change.

For Office Use

How to Use This Template

1. Include in your onboarding packet. Hand this form to every new hire on their first day, or send it electronically before they start.
2. Explain the medical section. Let employees know that Section 4 is optional but can be critical during a medical emergency. Emphasize that the information will be kept confidential.
3. Store securely. Keep completed forms in a secure location. Medical information should be stored separately from the general personnel file to limit access.
4. Schedule annual reviews. Set a recurring reminder to ask employees to review and update their emergency contacts. A good time is during open enrollment or annual performance reviews.
5. Make it accessible in an emergency. The people who might need this information -- supervisors, office managers, safety officers -- should know exactly where to find it quickly.

Tips for Small Businesses

• Collect at least two contacts. A primary contact may not always be reachable. Having a secondary contact reduces the chance of a dead end during an emergency.
• Keep a digital backup. If you store paper forms, scan them and save a digital copy in a secure, backed-up location.
• Consider remote workers. If employees work from home or travel, make sure you have their current home address and local emergency contacts, not just their office-area information.
• Review after workplace incidents. Any time there is a safety event, check whether your emergency contact records are current.

Keeping emergency contacts organized across a growing team gets complicated fast. Boring HR's Team Tracker and Cert Tracker let you store employee details, safety certifications, and critical records in one secure place -- so you can find what you need the moment it matters.