Get Employee Emergency Self-identification Form

This guide provides clear and supportive instructions for completing the Employee Emergency Self-Identification Form online. It is essential for employees to identify their needs for assistance during emergencies to ensure their safety and well-being.

Follow the steps to effectively complete the form online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by filling in your name. Provide your last name, first name, and middle initial in the designated fields.
3. Enter the current date in the date field.
4. Specify your organization by entering the name in the respective field.
5. Indicate your work station location. Select either 'MIB' or 'SIB' and fill in your room number.
6. Provide your office phone number in the appropriate space.
7. Fill in your cell phone or text pager number, ensuring to include the area code.
8. Enter your email address in the designated field.
9. If applicable, input your Blackberry PIN for emergency communication.
10. Detail your work schedule, for example, 'Monday-Friday, 8:00 am-5:00 pm'.
11. Input the name of your supervisor, including last name, first name, and middle initial.
12. Provide your supervisor’s office phone number and room number.
13. Obtain your supervisor's signature where indicated.
14. Enter the name of your buddy for emergencies, along with their contact information.
15. If applicable, provide details for an alternate buddy with their contact information.
16. Select any disabilities or medical conditions that apply to you from the provided list.
17. Specify the type of assistance you require during an emergency evacuation.
18. If you prefer to use evacuation chairs, list the trained volunteers who will assist you, including their contact information.
19. Review all filled sections to ensure accuracy before finalizing.
20. Once completed, save your changes, and choose to download, print, or share the form as needed.

Complete your Employee Emergency Self-Identification Form online today to ensure your safety during emergencies.