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EMERGENCY CONTACT NUMBERS
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EMERGENCY CONTACT NUMBERS
EMERGENCY CONTACT NUMBERS
In case of a serious medical emergency
EMPLOYEE NAME:
PHONE#
EMERGENCY CONTACT:
PHONE#
(Relationship)
EMERGENCY CONTACT:
PHONE#
(Relationship)
EMERGENCY CONTACT:
PHONE#
(Relationship)
EMERGENCY CONTACT:
PHONE#
(Relationship)
HOSPITAL PREFERENCE:
PHONE#
SIGNATURE
Date