Employee Emergency Contact Form for Danny Etienne, June 2018

EMERGENCY CONTACT FORM

Company: LSJE, LLC Address: 6100 Red Hook Quarters Suite B-3 St. Thomas, VI 00802 Tel: 340-775-8100 | Fax: 340-775-8108

Start Date: [blank]

Employee Name: Danny Etienne Address: [REDACTED] Date of Birth: [REDACTED]

Phone: [REDACTED] Cell: [REDACTED] E-Mail: [blank]

Title/Position: Maintenance/Manager Marital Status: Single License: [blank]

ALLERGIES OR HEALTH CONCERNS: [blank]

Blood Type: [blank]

CURRENT MEDICATION: [blank]

Doctor's Name: Douglass | Phone: [blank] Doctor's Name: Douglass | Phone: [blank]

IN CASE OF AN EMERGENCY, PLEASE CONTACT:

1. Name: Maria | Relationship: Etienne | Phone: [REDACTED]

2. Name: [REDACTED] | Relationship: Girlfriend | Phone: [REDACTED]

Footer: "This Information is for your safety and the safety of others"

Names mentioned: - Danny Etienne — Employee for whom this emergency contact form was completed; held position in Maintenance/Manager role - Maria Etienne — Emergency contact; relationship listed as 'Etienne' (possibly family member) - Douglass — Physician listed twice as doctor's name; phone numbers redacted