Emergency contact form.
A simple emergency-contact form for every employee. Two contacts, medical-info-on-request field, and a privacy block about how the data is held.
EMERGENCY CONTACT FORM — [Company Name] Employee: ________________________ ID: ____________ Role: ________________________ Location: ____________ Date: ____________ PRIMARY CONTACT Name: ________________________ Relationship: ____________ Mobile: ____________ Alternate phone: ____________ Address: _________________________________________________…
What's inside the document.
Name, employee ID, role, location.
Name, relationship, mobile, alternate phone, address.
Same fields. Required where the primary contact is unreachable or local.
Conditions or allergies the employee chooses to disclose for emergency response. Voluntary.
Authorisation for HR/manager to contact in genuine emergencies; revocable by the employee.
How the data is held, who can access it, retention period, deletion on departure.
A complete document set.
- Word document (.docx) — fully editable
- PDF — fillable signature-ready
- Google Docs — one-click copy to your Drive
- 12 months of updates to this form
- Commercial-use licence for internal and client work
Three formats, one document.
- Word document (.docx) — fully editable
- PDF — signature-ready
- Google Docs — one-click copy to your Drive
4 steps from download to use.
- 01Collect on day 1 alongside the new-hire onboarding form.
- 02Hold in HR records with restricted access; only HR and the employee's manager should see it.
- 03Update annually or whenever the employee notifies HR of a change.
- 04Delete on departure per your data-retention policy.
The right document at the right moment.
Use for every employee. The form is short, the data sensitive — handle the privacy block seriously.
Pair with the new-hire onboarding form at day 1; refresh annually as part of the data-accuracy check.
Honest answers before you download.
- Is medical info mandatory?
- No. Medical-info disclosure must be voluntary, used only for emergency response, and held under appropriate access controls. Coerced disclosure is a privacy and discrimination risk.
- Who can access this data?
- HR and the employee's direct manager. Wider access is rarely justified and should be documented in the privacy block.
- How long do I retain the data?
- For the duration of employment plus any retention period required by your jurisdiction's recordkeeping rules. Often deleted within 30 days of departure.
This emergency contact form template is a professionally drafted starting point and is not legal advice. The clauses follow current US and AU practice; adapt the document for your specific jurisdiction and have qualified counsel review any clauses you add before signing or distributing. Full disclaimer.