Emergency Contact Form for Brian Bates, LSJE LLC Contractor
An emergency contact form completed on 10/17/18 for Brian Bates, listed as a Contractor with LSJE LLC (based in St. Thomas, Virgin Islands). The form contains personal information including marital status (single), health details, physician information (Jamie Reed), and emergency contact designating a girlfriend. Multiple fields are redacted.
Document Transcript
EMERGENCY CONTACT FORM Company: LSJE, LLC Address: 6100 Red Hook Quarters, Suite B-3, St. Thomas, VI 00802-1348 Email: thesaintjames.group@gmail.com
FORM DETAILS: Today's Date: 10/17/18 Start Date: [blank] Employee Name: Brian Bates Date of Birth: [redacted] Physical Address: [redacted] Mailing Address: [redacted] Cell Phone: [redacted] Phone (other): [blank] E-mail: [blank] Title/Position: Contractor Marital Status: Single Driver's License No: [redacted]
HEALTH INFORMATION: Allergies or Health Concerns: [redacted] Blood Type: Unknown Current Medications: None Doctor's Name: Jamie Reed Doctor's Phone: [redacted] Doctor's Name (2): None Doctor's Phone (2): [blank]
EMERGENCY CONTACT: Name: [redacted] Relationship: Girlfriend Phone: [redacted] Name (2): [blank] Relationship (2): [blank] Phone (2): [blank]
Statement: 'This information is for your safety and the safety of others.'
Names mentioned: - Brian Bates — Employee/Contractor at LSJE LLC - Jamie Reed — Primary physician/doctor
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Type
OtherSource
DOJ - Data Set 1Release Date
January 24, 2025
Pages
1
File Size
485.0 KB
Format
Data Set
data-set-1
OCR Confidence
ID: EFTA00003044
Last updated: Apr 27, 2026
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