COLORADO SCHOOL OF MINES - Download as DOC

							                     COLORADO SCHOOL OF MINES
                         Emergency Contact Information




Employee name:__________________________________________________

Employee home phone number:__________________Cell_________________

Name of contact person in case of emergency:___________________________

Contact person’s address:___________________________________________

                           ___________________________________________

Contact person’s phone number: home:______________ work:______________

Relationship to employee:____________________________________________


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

________________________________________________________________

________________________________________________________________

________________________________________________________________

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