Employee Emergency Contact Form for Stephanie Remington

LSJE, LLC 6100 Red Hook Quarters Suite B-3 St. Thomas, VI 00802 Tel: 340-775-8100 | Fax: 340-775-8108

--- EMERGENCY CONTACT FORM ---

Start Date: 08/26/2018

Employee Name: Stephanie Remington Address: [REDACTED] 8-1-3 Estate Smith Bay 00802 Date of Birth: [REDACTED] Phone: [REDACTED] Cell: [REDACTED] E-Mail: [REDACTED] Title / Position: Asst to Manager Marital Status: Single License: [REDACTED]

--- EMERGENCY INFORMATION ---

Allergies or Health Concerns: [REDACTED] Blood Type: [REDACTED] Current Medication: [REDACTED] Doctor's Name: Island Health & Wellness Center Phone: [REDACTED] Doctor's Name: [BLANK] Phone: [BLANK]

--- IN CASE OF AN EMERGENCY, PLEASE CONTACT ---

Name: [REDACTED] | Relationship: Friend | Phone: [REDACTED] Name: [REDACTED] | Relationship: Son | Phone: [REDACTED]

This Information is for your safety and the safety of others

Names mentioned: - Stephanie Remington — Employee; position: Assistant to Manager; start date 08/26/2018