Employee Emergency Information Contact Form 2026

1. Click ‘Get Form’ to open the Employee Emergency Information Contact Form in the editor.
2. Begin by filling out the 'Employee Information' section. Enter your full name, address, city, state, zip code, social security number, date of birth, phone number, cell number, school, and position accurately.
3. Next, provide details for your primary emergency contact. Include their name, relationship to you, cell number, and work phone number.
4. Then, fill out the secondary contact information in the same manner as the primary contact.
5. In the 'Preferred Medical Treatment Person/Location' section, list your preferred doctor and dentist along with their office numbers. Also specify your preferred hospital.
6. Indicate whether you give permission for another doctor or dentist to treat you if your preferred options are unavailable by selecting 'Yes' or 'No'.
7. Complete any additional medical information such as allergies and current medications in the comments section.
8. Finally, sign and date the form at the bottom before submitting it back to Human Resources.

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