DocDraft Logo

Emergency Contact Information Form: Essential Guide for Businesses

Learn why emergency contact forms are crucial for your business, how to implement them properly, and best practices for HR managers, startup founders, and small business owners.

Introduction

An Emergency Contact Information Form is a vital document that collects essential information about whom to contact in case an employee experiences a medical emergency, accident, or other urgent situation in the workplace. For HR managers, startup founders, and small business owners, implementing this simple yet critical document can make all the difference during unexpected situations. This form typically collects details about an employee's preferred emergency contacts, including their relationship to the employee, contact information, and sometimes medical information like allergies or conditions first responders should know about. While straightforward in purpose, properly implementing emergency contact procedures requires attention to privacy concerns, regular updates, and accessibility considerations.

Key Things to Know

  1. 1

    Emergency contact forms should be treated as confidential information and stored securely with limited access by authorized personnel only.

  2. 2

    While collecting emergency contact information is important, employees generally cannot be legally required to provide it—though you can strongly encourage completion.

  3. 3

    Consider creating digital and physical backup systems for emergency contacts that can be accessed during various emergency scenarios, including power outages or evacuations.

  4. 4

    Include clear instructions for HR staff or managers about when and how to use emergency contact information to avoid inappropriate use.

  5. 5

    For remote or distributed teams, ensure emergency contact systems account for different locations and potential language barriers.

  6. 6

    Review your emergency contact procedures with legal counsel to ensure compliance with local regulations and privacy laws in all jurisdictions where you have employees.

  7. 7

    Consider implementing a verification process where employees confirm their emergency contacts are aware they've been listed and consent to being contacted.

Key Decisions

Small Business Owner

Startup Founder

HR Manager in Growing Company

Customize your Emergency Contact Information Form Template with DocDraft

EMPLOYEE EMERGENCY CONTACT INFORMATION FORM

Form Version: 1.0 | Last Updated: [MONTH] [YEAR]

CONFIDENTIAL INFORMATION

This document contains confidential personal and medical information protected by applicable privacy laws. Access is restricted to authorized personnel only.

I. EMPLOYEE INFORMATION

Full Legal Name: _______________________________ _________________ _______________________________ (First) (Middle) (Last)

Employee ID Number: _______________________________

Department: _______________________________ Position/Title: _______________________________

Work Location:

  • Building: _______________________________
  • Floor: _______________________________
  • Office/Desk Number: _______________________________

Employee Contact Information:

  • Cell Phone: _______________________________
  • Home Phone: _______________________________
  • Personal Email: _______________________________
  • Home Address: _______________________________ City: _______________________________ State: _______ ZIP: _____________

II. PRIMARY EMERGENCY CONTACT

Full Legal Name: _______________________________ _________________ _______________________________ (First) (Middle) (Last)

Relationship to Employee: _______________________________

Contact Phone Numbers:

  • Cell Phone: _______________________________ ☐ Preferred contact method
  • Home Phone: _______________________________ ☐ Preferred contact method
  • Work Phone: _______________________________ ☐ Preferred contact method

Email Address: _______________________________

Physical Address: _______________________________ City: _______________________________ State: _______ ZIP: _____________ Country (if outside the U.S.): _______________________________

Languages Spoken: _______________________________

Best Times to Contact: _______________________________

III. SECONDARY EMERGENCY CONTACT

Full Legal Name: _______________________________ _________________ _______________________________ (First) (Middle) (Last)

Relationship to Employee: _______________________________

Contact Phone Numbers:

  • Cell Phone: _______________________________ ☐ Preferred contact method
  • Home Phone: _______________________________ ☐ Preferred contact method
  • Work Phone: _______________________________ ☐ Preferred contact method

Email Address: _______________________________

Physical Address: _______________________________ City: _______________________________ State: _______ ZIP: _____________ Country (if outside the U.S.): _______________________________

Languages Spoken: _______________________________

Best Times to Contact: _______________________________

IV. MEDICAL INFORMATION (OPTIONAL)

Providing this information is voluntary but may assist emergency medical personnel in providing appropriate care.

Medical Conditions: (Please list any conditions that emergency responders should be aware of)

Severe Allergies: (Please list any allergies that could require emergency treatment)

Current Medications: (Please list medications that might be relevant in an emergency)

Blood Type (if known): _______________________________

Primary Physician Information:

  • Name: _______________________________
  • Phone Number: _______________________________
  • Medical Practice/Hospital: _______________________________

Health Insurance Information:

  • Provider Name: _______________________________
  • Policy Number: _______________________________
  • Group Number: _______________________________
  • Member Services Phone: _______________________________

V. SPECIAL INSTRUCTIONS

Special Emergency Instructions: (Optional - any specific instructions you want followed in case of emergency)

Religious Preferences: (Optional - any religious considerations relevant in a medical emergency)

Do Not Contact: (Optional - list individuals who should NOT be contacted under any circumstances)

VI. PRIVACY STATEMENT AND CONSENT

Privacy Statement:

The information collected in this Emergency Contact Information Form ("Form") is gathered solely for use in emergency situations involving the employee named herein. [COMPANY NAME] ("Company") recognizes the sensitive nature of this information and is committed to maintaining its confidentiality in accordance with all applicable privacy laws and regulations, including but not limited to the Health Insurance Portability and Accountability Act of 1996 ("HIPAA") where applicable.

This information will be:

  1. Stored securely in both electronic and physical formats with appropriate safeguards;
  2. Accessible only to authorized personnel with a legitimate need to know in emergency situations;
  3. Never used for any purpose other than responding to an emergency involving the employee;
  4. Retained only for as long as the individual remains employed with the Company, plus any additional period required by applicable law; and
  5. Properly disposed of through secure methods when no longer needed.

Consent for Information Collection and Disclosure:

By completing and signing this Form, I, the undersigned employee, voluntarily provide the information contained herein and expressly consent to:

  1. The collection and storage of this information by the Company for emergency purposes;
  2. The disclosure of this information to emergency medical personnel, first responders, or other emergency services in the event of a medical or other emergency involving me;
  3. The disclosure of this information to the designated emergency contacts listed on this Form in the event of an emergency; and
  4. The Company contacting my designated emergency contacts in the event of an emergency.

I understand that:

  • Providing medical information in Section IV is completely voluntary;
  • I may update or revoke this consent at any time by submitting a new Form;
  • It is my responsibility to keep this information current and accurate; and
  • The Company will make reasonable efforts to protect the confidentiality of this information but cannot guarantee absolute confidentiality in all circumstances.

HIPAA Compliance Statement:

Any medical information provided in this Form is protected health information under HIPAA. The Company will maintain this information in accordance with HIPAA requirements, including maintaining appropriate administrative, physical, and technical safeguards to protect the confidentiality, integrity, and availability of this information. This information will only be disclosed as permitted by HIPAA or as authorized by this consent.

VII. FORM ADMINISTRATION

Last Update Date: _______________________________

Annual Review Reminder:

Employees are required to review and update their emergency contact information at least annually or whenever significant changes occur (such as changes in contact information, medical conditions, or emergency contacts). The Company will send periodic reminders to facilitate this process, but ultimate responsibility for maintaining current information rests with the employee.

HR Contact Information:

For questions or assistance regarding this form, please contact:

  • HR Department: _______________________________
  • Phone: _______________________________
  • Email: _______________________________
  • Office Location: _______________________________

VIII. EMERGENCY INFORMATION ACCESSIBILITY PLAN

Accessibility of Emergency Contact Information:

This emergency contact information will be:

  1. Maintained in the Company's secure Human Resources Information System (HRIS);
  2. Available in physical form in a secure location accessible to designated emergency response personnel;
  3. Accessible to authorized personnel 24 hours a day, 7 days a week through secure protocols;
  4. Available to designated emergency coordinators on each floor/department; and
  5. Accessible through secure emergency protocols during after-hours emergencies.

Digital and Physical Storage:

This information will be stored:

  1. Digitally in encrypted format within the Company's secure HRIS, protected by appropriate access controls, regular security updates, and backup procedures;
  2. Physically in sealed envelopes in a locked, fire-resistant cabinet accessible only to authorized personnel; and
  3. In compliance with all applicable data protection and privacy laws.

In the event of power outages or system failures, designated emergency personnel will have access to physical copies through established emergency protocols.

IX. LEGAL COMPLIANCE

ADA Compliance Statement:

This Form and the Company's emergency procedures comply with the Americans with Disabilities Act (ADA). Employees with disabilities may request reasonable accommodations regarding emergency procedures by contacting the HR Department. The Company is committed to ensuring that all employees, regardless of disability status, have equal access to emergency services and support.

State-Specific Requirements:

This Form is designed to comply with all applicable state laws regarding the collection, storage, and use of emergency contact information. The Company acknowledges that state requirements may vary and commits to maintaining compliance with the specific requirements of each state in which it operates. Employees may request information about state-specific requirements by contacting the HR Department.

X. EMPLOYEE ACKNOWLEDGMENT

I, the undersigned employee, acknowledge that:

  1. I have voluntarily provided the information contained in this Form;
  2. I have read and understand the privacy statement and consent provisions;
  3. I understand it is my responsibility to keep this information current and accurate;
  4. I will notify the HR Department promptly of any changes to this information; and
  5. I consent to the use of this information as described in this Form.

Employee Signature: _______________________________ Date: _________________

Print Name: _______________________________

FOR HR USE ONLY

Received by: _______________________________ Date: _________________

Entered into HRIS by: _______________________________ Date: _________________

Next scheduled review date: _________________

Washington Dc Requirements for Emergency Contact Information Form

HIPAA Compliance (42 U.S.C. § 1320d-6)

Emergency contact forms must comply with the Health Insurance Portability and Accountability Act (HIPAA) privacy rules when they contain protected health information. Employers must safeguard any medical information collected and limit access to authorized personnel only.

Americans with Disabilities Act Compliance (42 U.S.C. § 12101 et seq.)

Emergency contact forms and procedures must accommodate employees with disabilities and ensure equal access to emergency services and evacuation procedures.

DC Personal Information Protection Act (D.C. Code § 28-3851 et seq.)

Businesses in DC must implement reasonable security procedures to protect personal information, including emergency contact details, from unauthorized access or disclosure.

DC Consumer Security Breach Notification Act (D.C. Code § 28-3851 et seq.)

Organizations must notify individuals if their personal information, which may include emergency contact information, has been compromised in a security breach.

DC Human Rights Act (D.C. Code § 2-1401.01 et seq.)

Emergency contact forms must not be used to discriminate against employees based on protected characteristics and must respect diversity in family structures and emergency contact relationships.

OSHA Emergency Action Plan Requirements (29 C.F.R. § 1910.38)

Employers must maintain emergency contact information as part of their comprehensive emergency action plan to ensure proper notification procedures during workplace emergencies.

DC Paid Family Leave Act (D.C. Code § 32-541.01 et seq.)

Emergency contact information may be relevant for administering paid family leave benefits, particularly when employees need to care for family members in emergency situations.

DC Workplace Safety Regulations (D.C. Code § 32-1101 et seq.)

Employers must maintain emergency contact information as part of their workplace safety protocols to ensure prompt notification in case of workplace injuries or accidents.

Family Educational Rights and Privacy Act (20 U.S.C. § 1232g)

For educational institutions in DC, emergency contact information for students must be handled in accordance with FERPA privacy protections.

DC Language Access Act (D.C. Code § 2-1931 et seq.)

Emergency contact forms should be available in multiple languages to ensure that employees with limited English proficiency can provide accurate information.

Electronic Signatures in Global and National Commerce Act (15 U.S.C. § 7001 et seq.)

If emergency contact forms are completed electronically, they must comply with E-SIGN Act requirements for electronic signatures and records.

DC Uniform Electronic Transactions Act (D.C. Code § 28-4901 et seq.)

Electronic emergency contact forms must comply with DC's implementation of the Uniform Electronic Transactions Act regarding electronic signatures and records.

DC Data Breach Notification Requirements (D.C. Code § 28-3852)

Organizations must have procedures in place to notify individuals if their emergency contact information is compromised in a data breach.

Employee Retirement Income Security Act (29 U.S.C. § 1001 et seq.)

Emergency contact information may be relevant for ERISA compliance, particularly for beneficiary designations and notifications related to employee benefits.

DC Universal Paid Leave Amendment Act (D.C. Code § 32-541.01 et seq.)

Emergency contact information may be necessary for administering paid leave benefits, especially when employees need to care for family members in emergency situations.

Genetic Information Nondiscrimination Act (42 U.S.C. § 2000ff et seq.)

If emergency contact forms collect any family medical history or genetic information, they must comply with GINA's protections against discrimination based on genetic information.

DC Office of Disability Rights Requirements (D.C. Code § 2-1431.01 et seq.)

Emergency contact procedures must be accessible to employees with disabilities in accordance with DC Office of Disability Rights guidelines.

DC Protecting Pregnant Workers Fairness Act (D.C. Code § 32-1231.01 et seq.)

Emergency contact procedures must accommodate the needs of pregnant employees, including potential modifications to emergency response protocols.

National Labor Relations Act (29 U.S.C. § 151 et seq.)

Implementation of emergency contact procedures may be subject to collective bargaining in unionized workplaces, requiring employer consultation with union representatives.

DC Family and Medical Leave Act (D.C. Code § 32-501 et seq.)

Emergency contact information may be relevant for administering DC FMLA benefits, particularly when employees need to care for family members in emergency situations.

Frequently Asked Questions

Emergency Contact Information Forms are necessary for several important reasons: 1) They provide immediate access to crucial contacts during workplace emergencies, potentially saving lives; 2) They demonstrate your company's commitment to employee safety and well-being; 3) They help fulfill your duty of care obligations as an employer; 4) They streamline communication during critical situations when every minute counts; and 5) In many jurisdictions, maintaining emergency contact information is required for compliance with workplace safety regulations. For startups and small businesses especially, having these systems in place early establishes good practices as your company grows.

A comprehensive Emergency Contact Information Form should include: 1) Employee information (full name, department, work location); 2) Primary emergency contact (name, relationship, phone numbers, email, address); 3) Secondary emergency contact details; 4) Medical information (optional but valuable) such as allergies, medications, or conditions first responders should know about; 5) Employee's healthcare provider information; 6) Any specific instructions the employee wishes to provide in case of emergency; and 7) Date and employee signature. Always include a privacy statement explaining how this sensitive information will be stored, used, and protected.

Emergency Contact Information Forms should be updated at minimum annually to ensure accuracy. However, best practices include: 1) Implementing a formal annual review process where employees verify or update their information; 2) Creating a simple process for employees to update their information whenever changes occur (like contact phone numbers or relationships); 3) Sending periodic reminders (quarterly or semi-annually) encouraging employees to review their emergency contact details; 4) Including emergency contact verification as part of performance reviews or other regular HR touchpoints; and 5) Requiring updates during significant company changes such as office relocations or reorganizations.

Emergency contact information contains sensitive personal data and must be handled with appropriate security measures: 1) Store information in secure, password-protected HR systems with restricted access; 2) If using paper forms, keep them in locked cabinets with limited access; 3) Clearly define which staff members have access to this information and under what circumstances; 4) Develop a clear data retention policy that complies with relevant privacy laws; 5) Consider using encrypted digital storage solutions; 6) Ensure compliance with applicable data protection regulations like GDPR or state privacy laws; and 7) Create a process for securely disposing of outdated information when employees leave the company.

For small businesses and startups, implementing Emergency Contact Forms can be straightforward: 1) Create a simple, clear form using templates available from HR resources or customize one to your needs; 2) Introduce the form during employee onboarding as a standard procedure; 3) Use secure digital solutions like HR software, encrypted spreadsheets, or even secure cloud storage for small teams; 4) Assign responsibility for maintaining and accessing these records to specific individuals; 5) Create a simple process for regular updates; 6) For very small teams, consider using secure HR apps designed for small businesses that include emergency contact management; and 7) Make sure the information is accessible during emergencies, even if your primary systems are down (consider backup procedures).

When implementing Emergency Contact Forms with your existing team: 1) Communicate the purpose clearly, emphasizing employee safety rather than compliance; 2) Explain how the information will be used, stored, and protected; 3) Set a reasonable deadline for completion; 4) Provide both digital and paper options if possible; 5) Consider introducing the forms during a company meeting or training session where you can address questions; 6) Follow up individually with employees who haven't submitted their forms; 7) Make the process as simple as possible; and 8) For startups and small businesses, a personal approach from founders or leadership can emphasize the importance of this safety measure.