Employee Emergency Contact Form for Hilian Bedminster

EMERGENCY CONTACT FORM LSJE, LLC 6100 Red Hook Quarters Suite B-3, St. Thomas, VI 00802 [Telephone and Fax redacted]

Start Date: [blank]

Employee Name: Hilian Bedminster Address: [redacted] SNQ14D Date of Birth: [redacted]

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

Title/Position: Painter Marital Status: Single License: [redacted]

ALLERGIES OR HEALTH CONCERNS: [blank]

BLOOD TYPE: [redacted]

CURRENT MEDICATION: [blank]

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

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

IN CASE OF AN EMERGENCY, PLEASE CONTACT:

Name: [redacted] Relationship: Mother Phone: [redacted]

Name: Ann Relationship: Amy [Note: appears to be Amy, likely sister or relative] Phone: [redacted]

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

Names mentioned: - Hilian Bedminster — Employee; position: Painter - Ann — Emergency contact; relationship listed as 'Amy' (likely family member)