Employee Medical Emergency Information Record Form

Employees working anywhere in the world for any owner, are entitled to many allowances from their companies and owners, in addition to their salaries. Every business follows a code of conduct for treating their employees humanely and making sure that their health is prioritized at all costs. Mostly, employees are represented by legal counsel to explain to them all the terms and conditions of their employment course.

An employee medical emergency information record form refers to a document that collects information about all the medical records of every employee working at a company. All this information is collected to help employees in emergency situations. These medical records may include,

  • Surgeries
  • Allergies
  • Medicinal reactions

First responders and healthcare providers are the first people to reach an emergency, but they cannot help a patient unless they are aware of their whole medical history. Medical emergency information about employees helps healthcare providers give appropriate medication to save their lives.

Employee Medical Emergency Information Record Form

File Size: 38 KB

Components of the form

Medical emergency record forms are collected at the time of the employee’s appointment and are updated when the employee undergoes any serious medical issue. These records are usually maintained online to make them easy to refer to in an emergency. Major information acquired through these records includes:

  • Employee’s profile: name, department, job description, and related information about the employee are added to the records to understand their role in the company.
  • Insurance number: records clearly mention if the employee acquires health insurance so that it can be charged for all hospital-related expenses.
  • Medical history: this section of the record shows all major as well as minor procedures that the employee underwent. It also includes allergies or reactions of all sorts, i.e. food, medicine, objects, etc. The medical history of the employee makes it easier for healthcare providers to understand the employee’s case and administer medicine properly.

Importance of the form

The medical records of employees are considered crucial and have helped hundreds of employees acquire the best medical care. It has the following advantages in the field of healthcare:

  • It helps companies and businesses to have a medical record of their employees so that employees can be helped financially when they need medical assistance.
  • Medical records help first responders understand the medical condition of the employee.
  • Companies provide insurance plans to their employees, which can be extended for employees suffering severely.
  • Medical records are collected from every employee to make sure that they are physically fit and can perform at their job.

Sample Form

Medical record forms are very simple and require information that can only be filled in by the employee. It is important to state all the records truthfully to get the best possible care from first responders.

The layout of an emergency information form is given below.

Name of employee:…

Age: ……………

D.O.B: ………………..

Job description:.

Department: ……………

Supervisor: ……………..

Emergency contact name:.

Contact # of emergency:…

Medical irregularities:

  1. …….
  2. …….
  3. ……..

Major procedures:.

Daily medication intake:

  1. ………
  2. ………
  3. ………

Blood group:…


  1. ……….
  2. ……….
  3. ……….


 Employee signature


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