# LSJE, LLC

6100 Red Hook Quarters Suite B-3 St. Thomas, VI 00802 Tel:

Fax:

# Emergency Contact Form

Date: 03/22/18
Start Date: 03/22/18

Employee Name: Boniface Loudat
Address: [redacted] St Thomas
Date of Birth: [redacted]

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

Role / Position: Carpenter Mason
Marital Status: Married
License: [redacted]

## wwwmergency Information:

Allergies or Health Concerns:
None
Blood type unspecified

Blood Type: <empty>

Current Medication:

Doctor's Name: Dodglas
Phone: <empty>

Doctor's Name: Dodglas
Phone: <empty>

In case of an Emergency, Please contact :
Name <empty> Relationship Wife Phone
Name <empty> Relationship In Law Phone

This Information is for your safety and the safety of others