Emergency Contact Form for Employee Peter Eli
This is an employee emergency contact form from LSJE, LLC, a St. Thomas-based entity. The form was marked 'Declined to Complete' and contains minimal information beyond the employee name 'Peter Eli.' The form is designed to collect personal details, medical information, and emergency contacts for workplace safety purposes.
Document Transcript
EMERGENCY CONTACT FORM
Company: LSJE, LLC Address: 6100 Red Hook Quarters, Suite B-3, St. Thomas, VI 00802-1348 Phone: [REDACTED] Email: thesaintjames.group@gmail.com
Form Status: DECLINED TO COMPLETE (handwritten notation at top)
Filled Fields: - Employee Name: Peter Eli
Unfilled Fields: - Today's Date: [blank] - Start Date: [blank] - Date of Birth: [blank] - Physical Address: [blank] - Mailing Address: [blank] - Cell Phone: [blank] - Phone (other): [blank] - E-mail: [blank] - Marital Status: [blank] - Title/Position: [blank] - Driver's License No: [blank] - Allergies or Health Concerns: [blank] - Blood type: [unchecked options: A-, A+, AB-, AB+, B-, B+, O-, O+, Unknown] - Current Medications: [blank] - Doctor's Name (two fields): [blank] - Doctor's Phone (two fields): [blank] - In case of emergency, please contact (two entries): - Name: [blank] - Relationship: [blank] - Phone: [blank]
Footer: 'This information is for your safety and the safety of others.'
Names mentioned: - Peter Eli — Employee for whom this emergency contact form was initiated but not completed
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Type
OtherSource
DOJ - Data Set 1Release Date
January 24, 2025
Pages
1
File Size
455.1 KB
Format
Data Set
data-set-1
OCR Confidence
ID: EFTA00003040
Last updated: Mar 9, 2026
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