Associate Emergency Questionnaire

Current Emergency Information

During an emergency, we will make every attempt to account for each of our associates. In an effort to ensure we can do this efficiently, please provide the information requested below.

Emergency:	Not Selected
Associate Name:
9-digit Associate ID:
Today's Date:
Current Location:
Current Phone Number:
Are you able to work	Not Selected Yes No
Can you or have you reached your supervisor?	Not Selected Yes No
What is your situation: