GRADIENTPEAK COACHING
Emergency-contact worksheet | Version 2026-10-27
BLANK WORKING TEMPLATE - review before operational use

This is not consent to testing, medical treatment, or data sharing.
Complete only when requested by your assessor. Agree a secure return method.
Do not complete this again if the adult health-history form already supplies
the required contact details. This is an alternative minimal contact record.
Do not upload the completed worksheet to a public activity, website, or repository.

Participant name: _____________________________________________________
Assessment date: _____________________________________________________
Emergency contact name: _______________________________________________
Relationship: ________________________________________________________
Primary phone (include country/area code): _____________________________
Alternative phone (optional): _________________________________________
Confirmation that this person is an appropriate emergency contact:
_____________________________________________________________________

Assessor: confirm accuracy privately and explain who can access this record,
why it is needed, and the applicable storage/retention arrangements.
This worksheet does not replace emergency services or a site-specific plan.