Illinois Emergency Information Form
Description
How to fill out Emergency Information Form?
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FAQ
An emergency contact is the first person medical personnel will get in touch with in an emergency, but your emergency contact may not have the legal authority to act on your behalf unless you explicitly provide that power.
Call 911 in the event of an imminent threat to health or safety. Call the preferred emergency contact.
In July 2009, the Illinois Secretary of State's Office created an Emergency Contact Database. The program is free and voluntary and allows any Illinois ID cardholder (e.g. driver's license, instruction permit or ID card) to designate one or two people to be contacted in case of an emergency, such as an auto crash.
Visit a Secretary of State facility, show required identification documents and have your photo taken. Surrender all valid out-of-state licenses, state ID cards, instruction permits and commercial driver's licenses. Pay the appropriate fee. Pass the appropriate exams (vision screening, written and/or driving).
Items to Put on an Emergency Contact ListFamily physician and hospital. The first name and number on your list should be your family's doctor and a local hospital.School contacts.Local contact.Next of kin.Work contact.Additional emergency contacts.Electric and utility companies.Poison control center.More items...?26-Jan-2022
To enroll in this program, go to and click on the Emergency Contact Database link listed under "Online Services".
The Emergency Contact Database allows you to voluntarily enter one or two individuals to serve as your emergency contacts in the event you are involved in a traffic crash or have a medical emergency where you cannot communicate directly with law enforcement or emergency responders.
The Emergency Contact Database allows you to voluntarily enter one or two individuals to serve as your emergency contacts in the event you are involved in a traffic crash or have a medical emergency where you cannot communicate directly with law enforcement or emergency responders.
The Employee Emergency Contact Form is used by an Employer to collect the contact information of an Employee's family or partner in case of emergency. For instance, if an Employee suffers an injury at the work place and must be taken to an Emergency Room, he or she may require a spouse or a parent to be contacted.
To enroll in this program, go to and click on the Emergency Contact Database link listed under "Online Services".