Number of Pages: 1
 
Who to use it with? 
Employees
 
What is it?
To be filled out by employees who voluntarily shares contact information for employer to contact during an emergency (e.g., medical) 
 
Why should you use it?
In the event of an emergency, employer will be able to reach out to the emergency contact of the employee
In the case an employee has shared a medical condition, employer should use this form to obtain authorization to share medical condition with the designated emergency contact during medical emergency 
 
Disclaimer/Recommendations:
This form asks for employee's voluntary disclosure of medical condition. Employer should follow state and local privacy regulations on how to properly store this document.