EMPLOYEE INFORMATION SHEET

Name: _______________________________________________________________
Position/Job Title: ______________________________________________________
Address: _____________________________________________________________
____________________________________________________________________
Home Phone: _________________________________________________________
Mobile Phone: ________________________________________________________
Emergency Contact Details*
Name: ______________________________________________________________
Address: ____________________________________________________________
Permanent Address: ___________________________________________________
____________________________________________________________________
Phone (Business Hours):
Phone (Business Hours):
Phone (Outside Business Hours):
Phone (Outside Business Hours):
If you would like your work colleagues to know about any conditions you have that may
assist in emergency care (eg. Haemophilia, diabetes, asthma) please provide details
below:
______________________________________________________________________
_______________________________________________________________________
____________________________________________________________________
______________________________________________________________________
Emergency Medical Contact (Name):
_____________________________________________________________________
Phone Number: ___________________________
*Note: It is important to ensure you have current information in case of emergency.
Please place on employee file and review regularly.