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Free form template · Word

Emergency Contact Form

An emergency contact form lists the people the company should call if an employee is injured, falls ill or cannot be reached, along with key medical information. It is collected at joining and should be refreshed whenever contacts change.

  • Editable Word (.docx)
  • Made for India
  • 7 fill-in fields highlighted
  • Free, no sign-up

Preview of the form

[Highlighted] = fill in
[Company Logo][Company Name]

EMERGENCY CONTACT FORM

Employee Name:
[Employee Name]
Employee ID:
[Employee ID]
Department:
[Department]
Work Location:
[Work Location]

1. Primary Emergency Contact

Name
Relationship
Mobile Number
Alternate Number
Address
Preferred Language

2. Secondary Emergency Contact

Name
Relationship
Mobile Number
Address

3. Local Contact (if family lives in another city)

Name
Relationship
Mobile Number

4. Medical Information (optional)

Blood Group
Known Allergies
Regular Medication
Medical Condition to be aware of
Family Doctor / Preferred Hospital and Phone
Health Insurance Policy No. (if any)

Consent and Declaration

I authorise [Company Name] to contact the persons named above and to share relevant information with them and with medical personnel in case of an emergency involving me. I confirm that these contacts are aware they have been named, and I will update this form when any detail changes.

Signature of Employee
[Employee Name]
Date: [Date]
Place: [Work Location]
Received by
[HR Name]
Date: [Date]

What this template includes

  • Primary contact with relationship and two phone numbers
  • Secondary contact in case the first is unreachable
  • Local contact for employees from other cities
  • Blood group, allergies and regular medication
  • Family doctor or preferred hospital
  • Consent to share information in an emergency

When to use it

  • At joining for every employee
  • Before field travel, site visits or outstation assignments
  • During an annual safety or records refresh
  • For employees living away from family, such as hostel or PG residents

How to customise this template

  1. 1Add a local guardian field for interns and trainees
  2. 2Add insurance policy number if group health cover exists
  3. 3Keep a copy with security or the site in-charge for plant roles
  4. 4Translate into the local language for shop-floor staff

HR tips

  • Ask for at least one contact who lives in the same city
  • Check that phone numbers are reachable by making a test call
  • Store a copy where it can be accessed after office hours
  • Remind employees yearly to update the form

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Frequently asked questions

Why do employers collect emergency contacts?+

So the company can quickly inform family or a trusted person if the employee has an accident, medical emergency or is missing.

Can an employee give a friend as emergency contact?+

Yes, any reachable adult the employee trusts can be named, though many people name a family member.

Is medical information mandatory on this form?+

It should be optional. Blood group and allergies are useful in emergencies, but employees should choose what to share.