Emergency Contacts (HR-F006)

EMERGENCY CONTACT (HR-F006)

Document Ref: HR-F006 (Employee Emergency Contacts)
Version: 1.0
Confidentiality Level: HIGH (HR Restricted)
CQC Alignment: Safe (Quality Statement: Safe and effective staffing)
Statutory Framework: Employment Rights Act 1996 | Health & Safety at Work Act 1974

SECTION 1: STAFF MEMBER DETAILS

Staff Member Name

Staff_ID

Operating Local Authority

Job Title

Home Address

Personal Mobile Number

SECTION 2: PRIMARY EMERGENCY CONTACT

Contact Name

Relationship to You

Primary Phone Number

Secondary Phone Number

Home Address

SECTION 3: SECONDARY EMERGENCY CONTACT

Do you wish to add a second emergency contact?

Contact Name

Relationship to You

Primary Phone Number

Secondary Phone Number

Home Address

SECTION 4: MEDICAL ALERT

Do you have any medical conditions or allergies that emergency responders should be aware of?

Medical Details (e.g., Diabetes, Epilepsy, Severe Allergies)

Instruction Note

SECTION 5: DATA CONSENT DECLARATION

Consent

Update Agreement

Electronic Signature (Full Name)

Date

Next Review Date: