Template · Employee records and administration
Emergency contact form
In short
An employee emergency contact form collects the names, relationships and phone numbers of the people to call if an employee is hurt, falls ill or cannot be reached at work, plus optional medical information the employee chooses to share. This template covers two contacts, a voluntary medical section, consent wording and a yearly review date.
Employee Emergency Contact Form template
Employee Emergency Contact Form
This information is used only to contact someone on your behalf in an emergency at work or if we cannot reach you. It is not a beneficiary designation for life insurance or retirement plans. The medical section is optional. Please update this form whenever your contacts change.
Employee information
- Full name
- Preferred name
- Employee ID
- Department / team
- Site / work location
- Work arrangement
- On siteRemoteHybridField / mobile
- Home address (used if we need to request a welfare check)
- Personal mobile phone
- Preferred language for emergency contact
Primary emergency contact
- Full name
- Relationship to employee
- Mobile phone
- Alternate phone
- Best times to reach
- Language spoken, if not English
Secondary emergency contact
- Full name
- Relationship to employee
- Mobile phone
- Alternate phone
- Language spoken, if not English
Optional medical information (voluntary)
- I choose to share medical information that could help emergency responders
- YesNo, leave this section blank
- Allergies (medication, food, insect stings)
- Medical conditions responders should know about (for example diabetes, epilepsy, heart condition)
- Location of emergency medication carried at work (for example epinephrine auto-injector, inhaler)
- Physician name and phone
- Preferred hospital
Consent and signature
- I confirm that the people listed have agreed to be my emergency contacts, and I authorize [Company Name] to contact them and to share relevant information with them and with emergency responders if I am injured, ill or cannot be reached.
- Employee signature
- Date
HR use only
- Received by
- Date entered in HRIS
- Medical section stored separately from personnel file
- Next review date (12 months)
How to use this template
- Include the form in the new hire paperwork so it is complete before the employee's first shift.
- Ask the employee to tell each contact they have been listed and to confirm the phone numbers are current.
- Explain that the medical section is optional and that it will be kept separate and confidential.
- Enter the contacts in the HRIS so supervisors on every shift can reach them without opening the paper file.
- File the signed form, storing any completed medical section in the confidential medical file rather than the personnel file.
- Ask employees to review and confirm their contacts once a year and after any life change.
Why every employer needs one
No federal law requires employers to collect emergency contacts, but almost every HR team does, and the first time a supervisor needs to call someone's family after a fall on the warehouse floor or a seizure at a contact center desk, the value is obvious. The form also helps when an employee simply stops showing up. Before treating repeated absences as job abandonment, many employers try the emergency contact to check the person is safe.
Collect it at hire alongside the new hire information form, not weeks later. In high-volume hiring, forms that are not part of the day-one packet tend never to get done.
What to include and why
Two contacts, not one. The primary contact is often a spouse or partner who may be at work and unreachable. A second contact in a different household is far more useful.
Relationship. Responders and hospitals ask. It also tells the supervisor how to frame the call.
Language. In diverse hourly workforces, a contact who speaks only Spanish or Vietnamese is common. Knowing that before the call lets you bring an interpreter or the right coworker.
Home address. For remote and work-at-home employees, this is what allows you to request a welfare check if an employee collapses on a video call. Confirm the address is where they actually work.
A plain statement that this is not a beneficiary form. Employees sometimes assume listing someone here means that person receives life insurance or retirement benefits. It does not, and saying so avoids painful confusion later.
Medical information and privacy
Keep the medical section voluntary and say so clearly on the form. Under the Americans with Disabilities Act, medical information an employer obtains about an employee must be kept confidential and stored separately from the general personnel file. That applies to allergies and conditions disclosed on this form too. Supervisors and first aid responders can be told what they need to act in an emergency, but the information should not sit in a file any manager can open.
Do not ask about family medical history or genetic information. The Genetic Information Nondiscrimination Act restricts employers from requesting it, and an open-ended "anything else we should know" box can invite it.
Outside the US, data protection laws such as the GDPR treat health data as a special category with stricter rules, and the contacts' own personal data also needs a lawful basis. Requirements vary by country and state, so check local rules.
Keeping contacts current
Emergency contact data goes stale faster than almost any other employee record. People change numbers, break up and move. Ask employees to confirm their contacts once a year, for example during open enrollment or the annual policy acknowledgement cycle, and prompt an update whenever someone submits an employee change form for a new address or name.
For multi-site and shift-based operations, the data has to be reachable at 3 a.m. by whoever is running the floor. A digital forms tool that writes contacts straight into the HRIS, with access limited to supervisors and HR, works better than a locked cabinet in an office that is closed on the night shift. Store it according to the rules in the personnel file checklist.
Common mistakes
- Making the medical section mandatory, or filing it in the personnel file.
- Listing the employee's own second phone as an emergency contact. Check that each contact is a different person.
- Never updating the form after hire, so the contact is a former partner from five years ago.
- Leaving the information in a paper file that night and weekend supervisors cannot reach.
- Using emergency contacts to chase routine attendance issues. Call them for safety concerns, not to ask why someone is late.
Frequently asked questions
Is an employee emergency contact form required by law?
Not under US federal law, and generally not under state law either, but it is standard practice. Employers cannot force an employee to list a contact, though most employees are happy to once they know how it is used.
What should an emergency contact information sheet include?
The employee's details and work location, at least two contacts with name, relationship, phone numbers and language, an optional medical section, a consent statement and a signature, plus a date for the next review.
Can employers ask for medical information on an emergency contact template?
Employers can invite employees to share it voluntarily. It must be kept confidential and stored separately from the personnel file under the ADA, and employers should not ask for family medical history or genetic information.
How often should emergency contact information be updated?
At least once a year and whenever the employee has a life change such as a move, marriage or divorce. Many employers tie the annual check to open enrollment.
Who can see an employee's emergency contact details?
HR and the supervisors or managers who may need to make the call, such as shift leads. Limit access to people with a real need, and keep any medical information more tightly restricted than the contacts themselves.