Updated April 11, 2023
An employee emergency contact form is a document that references an individual’s closest family members or friends in the event of a workplace accident or injury. It is commonly required during the hiring process and should be updated every 6-12 months.
Limiting Liability
If an employer does not properly respond to an injury, they could be liable for not providing a safe workplace. It is recommended for every business to have the emergency contact details of every employee in case there is an employment-related accident.
Sample
EMERGENCY CONTACT FORM FOR [COMPANY NAME]
EMPLOYEE DETAILS
Name: [NAME]
Title: [TITLE]
Employee ID: [#]
Department: [DEPT. NAME]
Address: [ADDRESS]
Phone: [PHONE]
E-Mail: [E-MAIL]
EMERGENCY CONTACT
- Primary Emergency Contact
- Name: [NAME]
- Relationship: [RELATIONSHIP]
- Address: [ADDRESS]
- Phone: [PHONE]
- E-Mail: [E-MAIL]
- 2nd Primary Emergency Contact
- Name: [NAME]
- Relationship: [RELATIONSHIP]
- Address: [ADDRESS]
- Phone: [PHONE]
- E-Mail: [E-MAIL]
- Primary Care Physician
- Name: [NAME]
- Phone: [PHONE]
- Address: [ADDRESS]
- Medical Information
- Health Insurance Provider: [PROVIDER]
- Policy Number: [ADDRESS]
- Allergies: [ALLERGIES]
- Medication: [MEDICATION]
CONSENT FOR MEDICAL CARE
In the event that I need emergency services: (check one)
☐ – I GIVE consent to medical treatment by any professional licensed to provide healthcare services.
☐ – I DO NOT consent to any type of medical treatment.
Signature: _________________________________
Date: _________________________________
Main Purpose
Though workplace injuries are generally rare, they do occur. When an employee is hurt on the job, supervision may have an ethical obligation to inform the next of kin or other close relatives or friends. In the worst case, contacting a family member or friend may be a logistical necessity.
For employers, it has become standard practice to request emergency contact information from all new hires – whether the job is risky or not. Though the employee may feel strange disclosing extra personal information, sharing a friend or relative’s phone number and other basic contact details is in the interest of both employer and employee.
There are other cases where an emergency contact can come into play. Consider an employee who abruptly stops showing up to work. The specified contact may be able to vouch for this person’s whereabouts. Similarly, in the case of an employee who is significantly incapacitated by injury or illness, the emergency contact may serve as a go-between should other relatives or friends contact the employer seeking the ailing worker.
Selecting an Emergency Contact
Injury and illness are personal and serious matters, so emergency contacts will usually be those with some personal connection, either family or friends of the employee. Expediency matters too, though – so employees should think about accessibility when selecting emergency contacts. Will the appointed person be reachable? Is the contact competent to handle high-stress situations?