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diiirect

Hiring, but direct. A platform and talent marketplace where companies, recruiters, and skilled professionals work together to move from role brief to qualified shortlist faster.

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Home/Templates/Onboarding & HR policies/Emergency contact form
Signable template

Emergency contact form

Collects a team member's emergency contacts and optional medical notes, with clear consent language about how the information is stored and used.

  • Made forEmployers
  • Reading time~1 min
  • What's includedFillable fields, signature blocks, and e-signature delivery through Diiirect.
Use this templateSign in or create a free account to customize and send for e-signature.

The template

This form asks for the people we should reach if something happens to you at work, plus any information that could help responders act quickly. Completing the medical section is optional.

1. Your details

Full name: Employee full name Role or team: Role or team Phone: Employee phone

2. Primary emergency contact

Name: Primary contact name Relationship: Primary contact relationship Phone: Primary contact phone Alternate phone or email: Primary contact alternate

3. Secondary emergency contact

Name: Secondary contact name Relationship: Secondary contact relationship Phone: Secondary contact phone

4. Optional medical notes

Allergies, conditions, or medications responders should know about. Leave blank if you prefer not to share.

Medical notes

5. How this information is used

  1. It is used only to reach your contacts, or to help responders, in an emergency.
  2. Access is limited to the people who administer HR records.
  3. You can update or remove this information at any time by submitting a new form.
  4. It is deleted according to the company's record-retention practices after you leave.

Signatures

I confirm the information above is accurate and consent to its storage and use as described.

Signature: ✍ Employee signature Date: Signature date

Highlighted fields are filled in when you customize and send this document on Diiirect.

Not legal advice

This template is provided for general informational purposes only and is not legal advice. Laws differ by jurisdiction and change over time — have a qualified professional review any document before you rely on it.

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