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Emergency Contact Form

This emergency contact form allows employees to provide contact information for two emergency contacts. It authorizes the company to notify the listed emergency contacts in the event of an emergency involving the employee. The employee provides their name and signature to confirm the listed emergency contact details.

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berne
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132 views1 page

Emergency Contact Form

This emergency contact form allows employees to provide contact information for two emergency contacts. It authorizes the company to notify the listed emergency contacts in the event of an emergency involving the employee. The employee provides their name and signature to confirm the listed emergency contact details.

Uploaded by

berne
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Emergency Contact Form

In the event of an emergency, I, the undersigned employee, authorize


(Company Name) to notify the following persons:

Employee Name _____________________________________________________________

First Emergency
Contact Name _____________________________________________________________

Address _____________________________________________________________

_____________________________________________________________

Phone _____________________________________________________________

Relation
to Employee _____________________________________________________________

Secondary Emergency
Contact Name _____________________________________________________________

Address _____________________________________________________________

_____________________________________________________________

Phone _____________________________________________________________

Relation
to Employee _____________________________________________________________

_____________________________________________________________
Employee Signature

_____________________________________________________________

Printed Employee Name

_____________________________________________________________

Date

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