Emergency Contact Form for Donald Pollon - LSJE LLC
This is an emergency contact form dated October 18, 2018, completed for an employee named Donald Pollon. The form was issued by LSJE, LLC, a company based in St. Thomas, Virgin Islands. The form captures personal contact information, health details, and emergency contact information. Most fields are blank or partially redacted, with only the employee name, date, and company information visible.
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 Phone: [REDACTED]
Today's Date: 10/18/18 Start Date: [BLANK]
Employee Name: Donald Pollon 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: [Checkboxes available for A-, A+, AB-, AB+, B-, B+, O-, O+, Unknown - none checked]
Current Medications: [BLANK]
Doctor's Name: [BLANK] Doctor's Phone: [BLANK]
Doctor's Name: [BLANK] Doctor's Phone: [BLANK]
In case of emergency, please contact: Name: [REDACTED] Relationship: [BLANK] Phone: [REDACTED]
Name: [REDACTED] Relationship: [BLANK] Phone: [REDACTED]
Footer: "This information is for your safety and the safety of others."
Names mentioned: - Donald Pollon — Employee completing the emergency contact form
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Type
OtherSource
DOJ - Data Set 1Release Date
January 24, 2025
Pages
1
File Size
470.2 KB
Format
Data Set
data-set-1
OCR Confidence
ID: EFTA00003050
Last updated: Mar 9, 2026
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