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Employee Emergency Contact Form

  1. Active City of Green Bay Employees:
    Please provide the Human Resources Department with the name of at least one person to be contacted in the event of a medical emergency. This information will be maintained confidentially for emergency use only.

    Notify your Supervisor if you have a medical condition of which you wish others to be aware in case of emergency.
  2. Please include the last 4 digits of employee's social security number for verification and security purposes.
  3. Emergency Contact #1
  4. Emergency Contact #2
  5. Leave This Blank:

  6. This field is not part of the form submission.