Employee Emergency Contact Form for Maintenance Staff Member
This is an emergency contact form from LSJE, LLC (a Virgin Islands entity) dated March 19, 2018, for an employee named Oriole Joseph who worked in maintenance starting October 1, 2016. The form contains personal information including address, phone, date of birth, marital status, medical information, and emergency contacts. Multiple fields are redacted with black bars, including the employee's address, date of birth, phone and cell numbers, email, and emergency contact names and phone numbers.
Document Transcript
EMERGENCY CONTACT FORM
Company: LSJE, LLC Address: 6100 Red Hook Quarters Suite B-3, St. Thomas, VI 00802 Telephone: 340-775-8100 Fax: 340-775-8108
Form Date: 03/19/18 Employee Start Date: 10/01/16
Employee Name: Oriole Joseph Address: [REDACTED] Date of Birth: [REDACTED]
Phone: [REDACTED] Cell: [REDACTED] E-Mail: [REDACTED]
Title/Position: Maintenance Marital Status: Single License: [blank]
Emergency Information: Allergies or Health Concerns: [blank] Blood Type: Unspecified Current Medication: [blank]
Doctor's Name: [blank] | Phone: [blank] Doctor's Name: [blank] | Phone: [blank]
In Case of Emergency, Please Contact: Name: [REDACTED] | Relationship: Cousin | Phone: [REDACTED] Name: [REDACTED] | Relationship: Cousin | Phone: [REDACTED]
Statement: 'This Information is for your safety and the safety of others'
Names mentioned: - Oriole Joseph — Employee in maintenance position at LSJE, LLC; started October 1, 2016
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Type
OtherSource
DOJ - Data Set 1Release Date
January 24, 2025
Pages
1
File Size
514.7 KB
Format
Data Set
data-set-1
OCR Confidence
ID: EFTA00003063
Last updated: May 24, 2026
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