Emergency Interim Successor Designation Form

Documents the primary and secondary interim leader for a critical role, including scope, authority, and notification steps if the incumbent departs suddenly.

Role and Activation Overview

• Critical role title
  Enter the role that requires emergency interim coverage.
• Incumbent name
  Name of the current role holder. Collect only if needed for continuity and notification.
• Department or business unit
• Activation trigger
  Select all situations that should activate this interim succession protocol.
• Other activation trigger
  Describe any additional trigger not listed above.
• Effective date
  Date this designation becomes active.
• Next review date
  Date the protocol should be reviewed and refreshed.

Primary Interim Successor

• Primary interim successor name
• Primary interim successor title
• Primary interim successor contact email
  Use a work email address for notification and audit trail purposes.
• When does the primary successor step in?
  Choose the approval path that applies before interim authority begins.
• Scope of authority
  Select the responsibilities the interim successor may exercise.
• Other scope of authority
• Decision limits and restrictions
  List any actions the interim successor may not take, including financial, legal, or personnel limits.

Secondary Interim Successor

• Secondary interim successor name
• Secondary interim successor title
• Secondary interim successor contact email
• When does the secondary successor step in?
  Describe the condition that activates the secondary successor, such as primary unavailability or conflict of interest.

Notification and Escalation Steps

• Primary notification method
• Notify HR/People Ops
• Notify IT / system access team
• Notify security / facilities
• Notify executive leadership
• Notification timeframe (hours)
  How quickly notifications should be completed after activation.
• Notification sequence
  List the order of notifications and any escalation steps if a contact does not respond.

Handoff, Access, and Continuity

• Key systems or tools requiring access review
• Access review notes
  Describe any access changes, temporary permissions, or approvals needed.
• Location of key documents
  Provide the location of SOPs, contact lists, and other essential documents.
• Immediate continuity tasks
  List the first actions the interim successor should take in the first 24-72 hours.

Acknowledgment and Audit Trail

• Prepared by
• Prepared by title
• Approver name
• Approver title
• Approval date
• Acknowledgment signature
  Optional signature acknowledging the designation and responsibilities.
• Comments or special instructions
  Add any notes, exceptions, or follow-up actions.