SayPro

Emergency Contact Form

Employee Information

• Full Name: ___________________________________________
• Department: __________________________________________
• Position: _____________________________________________
• Employee ID: _________________________________________
• Work Location: ________________________________________
• Phone Number (Work): _________________________________
• Phone Number (Mobile): _______________________________
• Email Address: ________________________________________

Emergency Contact Details

Medical Information (Optional)

• Known allergies: _________________________________________
• Medical conditions: ______________________________________
• Medications currently taken: ______________________________
• Other relevant medical information: _______________________

Authorization and Consent

I hereby authorize SayPro to contact the above-listed individuals in the event of an emergency. I confirm that the information provided is accurate to the best of my knowledge and will update it promptly if any changes occur.

• Employee Signature: _______________________
• Date: _______________________

For Office Use Only

• Form Received By: _______________________
• Date Received: _______________________
• Next Review Date: _______________________