Emergency Contact Form for Employee Dorn B. Donissaint, LSJE LLC
This is an emergency contact form dated April 10, 2018, completed for employee Dorn B. Donissaint employed by LSJE, LLC, a company located in St. Thomas, U.S. Virgin Islands. The form captures employee personal information, health details, and emergency contact information for workplace safety purposes. Most personal details including phone numbers, email, date of birth, and emergency contact information are redacted.
Document Transcript
EMERGENCY CONTACT FORM
Company: LSJE, LLC Address: 6100 Red Hook Quarters Suite B-3 St. Thomas, VI 00802
Form Date: 04/10/18 Start Date: 04/10/18
EMPLOYEE INFORMATION: Name: Dorn B. Donissaint Address: St. Thomas, VI 00802 Date of Birth: [REDACTED] Phone: [REDACTED] Cell: [REDACTED] E-Mail: [REDACTED] Title/Position: Labor [partially visible] Marital Status: Married License: [BLANK]
HEALTH INFORMATION: Allergies or Health Concerns: [BLANK] Blood Type: Not specified Current Medication: [BLANK] Doctor's Name: [BLANK] / Phone: [BLANK] Doctor's Name: [BLANK] / Phone: [BLANK]
EMERGENCY CONTACTS: Name: [REDACTED] Relationship: Friend Phone: [REDACTED]
Name: [BLANK] Relationship: [BLANK] Phone: [BLANK]
Footer: "This Information is for your safety and the safety of others"
Names mentioned: - Dorn B. Donissaint — Employee of LSJE, LLC; position appears to be in labor/maintenance role
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Type
OtherSource
DOJ - Data Set 1Release Date
January 24, 2025
Pages
1
File Size
462.6 KB
Format
Data Set
data-set-1
OCR Confidence
ID: EFTA00003051
Last updated: Apr 29, 2026
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