Employee Emergency Contact Form for Gerry Titre, Maintenance Staff

EMERGENCY CONTACT FORM

LSJE, LLC 6100 Red Hook Quarters Suite B-3 St. Thomas, VI 00802

Form Date: 03/20/18 Start Date: [blank]

Employee Name: Gerry Titre Address: St. Thomas, VI 00802 (partial address redacted) Date of Birth: [redacted] Phone: [redacted] Cell: [redacted] E-Mail: n/a

Title/Position: Maintenance Marital Status: Married License: [blank]

Emergency Information: Allergies or Health Concerns: [redacted] Blood Type: [redacted] Current Medication: [blank]

Doctor's Name: Red Hook Family Practice Phone: [blank]

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

In case of an Emergency, Please contact:

1. Name: Valerie | Relationship: Wife | Phone: [redacted]

2. Name: Gerrycia | Relationship: Daughter | Phone: [redacted]

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

Names mentioned: - Gerry Titre — Employee, maintenance staff position at LSJE, LLC - Valerie — Emergency contact, wife of Gerry Titre - Gerrycia — Emergency contact, daughter of Gerry Titre