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Emergency Contact Form


Despite your best efforts, workers may still get injured on the job. In the event of a safety incident or other emergency, you’ll need to contact the involved worker’s family or other designated emergency contact person. Although that information is likely in each worker’s personnel file, it’s good to have it on hand in the plant, on the job site, etc. so there are no delays.


List the names and numbers of emergency contacts for all workers. If possible, get two contacts for each worker and multiple numbers for each contact. It’s also beneficial to note any medical condition or special needs the worker may have that could be of importance to first responders, such as diabetic, heart condition, drug allergies, etc. Keep copies of this form in a secured but accessible part of the workplace and ensure that all supervisors know where they are. You may also want to give a copy of this form to first responders, especially if the injured worker is unconscious or can’t communicate.