COLORADO SCHOOL OF MINES

Emergency Contact Information

Today’s Date: ________________


Employee name:


Employee home phone number:
Cell


First/Last name for contact in case of emergency:


Contact person’s street address:



City, State, Zip

Contact person’s phone number: home:
work:


Relationship to employee:



Names and telephone numbers of persons to contact if primary contact is unavailable:






























Revision date 06.06.2017