Emergency Contact Form | Century Traffic

Emergency Contact Form

In the event of an emergency, Century Traffic would like to know who we should contact on your behalf. Please fill out this form and return it to Tracy Griswold. If your preferred emergency contacts should change, please let us know as soon as possible.

Employee Name

First Last

Employee Cell Phone

First Emergency Contact

Contact Name

First Last

Home Phone

Cell Phone

Work Phone

Relation to Employee

Second Emergency Contact

Contact Name

First Last

Home Phone

Cell Phone

Work Phone

Relation to Employee

I do not wish to provide Century Fence Company with any emergency contacts

Employee Name

First Last

Signature

Date

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