Employee emergency contact form
Emergency Contact Record
Confidential Workplace Safety File · sbon.org
Date updated: October 12, 2026
Employee Details
Name: Jordan Taylor
Phone: (414) 555-0182
Department: Operations & Warehouse
Home Address: 742 Evergreen St, Milwaukee, WI 53202
Primary Contact
Name: Morgan Taylor
Relationship: Spouse
Primary Phone: (414) 555-0199
Alternate Phone: (414) 555-0112
Secondary Contact
Name: Patricia Taylor
Relationship: Parent
Phone: (608) 555-0144
Medical Information (Voluntary)
Preferred Medical Facility: Froedtert Hospital / Medical Center
Primary Care Physician: Dr. Evans, (414) 555-0120
Allergies / Emergency Alerts: Severe penicillin allergy. Carries EpiPen for bee stings.
I confirm that the information provided above is accurate and may be used by the employer in the event of a medical emergency or accident involving me during work hours.
Employee Signature
Date
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Workplace emergency contact best practices
Why emergency contact records matter
In a workplace accident, medical event, or sudden evacuation, every minute counts. Having updated emergency contacts on file enables management to immediately notify loved ones and provide first responders with vital information (such as known drug allergies).
- Keep contacts updated: Ask employees to review and update emergency contacts annually or upon any life status change.
- Voluntary medical info: Providing medical conditions or allergies must always remain strictly voluntary for the employee under the Americans with Disabilities Act (ADA).
- Confidential storage: Emergency contact sheets should be kept in a confidential administrative file, accessible to managers only during legitimate health emergencies.
Common mistakes
The most common mistake is requiring employees to disclose private medical diagnoses. Emergency forms should specify that medical notes are voluntary and solely intended to assist paramedics or hospital staff in critical situations.