Here is a sample emergency disclosure form adapted from Facebook Law Enforcement Guidelines 2013.
EMERGENCY DISCLOSURE FORM
1. Describe the nature of the emergency (i.e. potential bodily harm, crime being committed):
2. Provide the identification of all users involved (Facebook user profile name, ID number, and Date of Birth):
3. Provide the exact location(s) of the evidence related to the described emergency:
I, [Officers Name], attest that the above-mentioned facts are true and accurate to the best of my knowledge.
Officers Signature & Badge # Date and Time