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Fillable Form Emergency Contact Information

This form is used to indicate the name of individuals and their contact information so they can be contacted in the case of an emergency.

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What is an Emergency Contact Information form?

An Emergency Contact Information form is a document that contains the names of reliable individuals and their contact information as backup contact in case of emergency.

As emergencies could happen anytime and anywhere, furnishing an Emergency Contact Information form is essential. In case of emergency, it could be used as a reference for an efficient action plan.

How to fill out an Emergency Contact Information form?

Name

Last

Enter your last name.

First

Enter your first name.

M.I.

Enter your middle initial.

Phone #

Enter your phone number.

Home

Enter your home or telephone number.

Cell

Enter your cell number.

Email

Enter your email address.

Address

Street

Enter your street address.

City

Enter your city.

State

Enter your state.

Zip

Enter your ZIP code.

Primary Emergency Contact Details

Enter your primary emergency contact’s details. Your primary contact will be the first individual to be contacted in case of an emergency.

Contact Name

Last

Enter your primary emergency contact’s last name.

First

Enter your primary emergency contact’s first name.

M.I.

Enter your primary emergency contact’s middle initial.

Relationship

Enter your relationship with your primary emergency contact.

Phone #

Enter your primary emergency contact’s phone number.

Home

Enter your primary emergency contact’s home or telephone number.

Cell

Enter your primary emergency contact’s cell number.

Email

Enter your primary emergency contact’s email.

Address

Enter your primary emergency contact’s address.

Street

Enter your primary emergency contact’s street address.

City

Enter your primary emergency contact’s city.

State

Enter your primary emergency contact’s state.

Zip

Enter your primary emergency contact’s ZIP code.

Secondary Emergency Contact Details

Enter your secondary emergency contact’s details. Your secondary contact will be contacted if the primary contact is not available.

Contact Name

Last

Enter your secondary emergency contact’s last name.

First

Enter your secondary emergency contact’s first name.

M.I.

Enter your secondary emergency contact’s middle initial.

Relationship

Enter your relationship with your secondary emergency contact details.

Phone #

Enter your secondary emergency contact’s phone number.

Home

Enter your secondary emergency contact’s home or telephone number.

Cell

Enter your secondary emergency contact’s cell number.

Email

Enter your secondary emergency contact’s email.

Address

Enter your secondary emergency contact’s address.

Street

Enter your secondary emergency contact’s street address.

City

Enter your secondary emergency contact’s city.

State

Enter your secondary emergency contact’s state.

Zip

Enter your secondary emergency contact’s ZIP code.

Medical Contact and Information

Doctor Name

Enter the doctor’s name.

Phone #

Enter the doctor’s phone number.

Medical Information

Enter any medical information. Also, include any special medical or personal information you would want an emergency care provider to know.

What is an emergency?

Emergencies pertain to events that possess an immediate risk to health, life, property, or the environment. It does not need to be fatal, but it requires urgent intervention for mitigation. It could be a minor, moderate, or a major emergency.

What are the four aspects of an emergency condition?

Dealing with emergencies depends on its level or condition. Usually, mitigation does not work in fatal emergencies. Follow the safety standards and acquaint yourself with these aspects of an emergency condition.

1. Temporal Character. Because an emergency is sudden, unforeseen, and of unknown duration, follow the four phases of emergency management — mitigation, preparedness, response, and recovery.

2. Potential Gravity. Do not underestimate early signs as emergencies could be dangerous and threatening to life and well-being.

3. Matter of Perception. The government, authority, or an individual must discern an emergency — recognizing its fatality and coming up with plans or solutions.

4. The Element of Response. An emergency requires urgent action, yet it could be sudden and unforeseen. Thus, it cannot always be dealt with according to the rule. The element of response could be spontaneous but must be effective.

However, an emergency does not always refer to life-threatening situations. A minor condition may be considered an emergency situation. For example, when a manager needs to contact his subordinate for an urgent meeting but the latter is unreachable, or when a student picks a fight at school and the principal needs to call the parents. Nonetheless, these kinds of emergency situations need an imperative response to prevent the worsening of the situation.

What are the four phases of Emergency Management?

Emergency Management refers to an individual’s ability to manage a crisis. Regardless of how harmless a situation is, it is best to enact safety precautions.

The four helpful phases of Emergency Management are highly recommended.

1. Mitigation. Mitigation includes activities that prevent an emergency, reduce its probability of occurrence, or minimize its damaging effect. This phase must be practiced before and after an emergency. For example, to protect your loved ones and home from fire, you must be careful in selecting building materials or appliances that may cause such an incident. It is also practical to apply for fire insurance to have financial assistance with the costly damages caused by the incident.

2. Preparedness. This phase must be practiced before an emergency. It includes making plans or preparations that will improve your chances of successfully dealing with an emergency. For example, an earthquake drill is an activity that helps individuals ensure their capability to manage themselves amidst an earthquake.

3. Response. This phase happens during an emergency. It pertains to the actions you perform to keep yourself and your loved ones safe. Thus, it is vital to do the first two phases as your safety depends on how prepared you are and how you react to an emergency. For instance, during an earthquake, you need to do basic drills such as drop, cover and hold. If you did not participate during an earthquake drill, you might be unprepared and clueless about what to do.

4. Recovery. The aftermath of some emergencies may cause stress-related illness. This phase pertains to your ability to cope with your challenges in rearranging your life and environment. Incorporating the three previous phases in your daily lifestyle is an immense help in your recovery stage.

Moreover, an Emergency Contact Information Form is an action plan under Mitigation and Preparedness phase, depending on how it is utilized.

Why do you need an Emergency Contact Information form?

You need an Emergency Contact Information form to:

1. Help the emergency care provider to recognize your profile;

2. Help the emergency care provider to know who to contact in case of emergency;

3. Help the emergency care provider to know any special or medical information about you such as allergies or diseases; and

4. Have a backup plan. An Emergency Contact Information form requires a list of reliable individuals to contact in case of an emergency. These individuals may help you with specific concerns if you are unreachable.

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