LSJE, LLC 6100 Red Hook Quarters Suite B-3 St. Thomas, VI 00802 Tel: 340-775-8100 Fax: 340-775-8108 Emergency Contact Form Date: 06/14/18 Employee Name: Felito Joseph Address: ,)nurvPr'osition. mergency irc:c,:t— Allergies or Health Concerns: Blood Type: Current Medication: Doctor's Name: Doctor's Name: Marital Status: Single Phone: Phone: In case of an Emergency, Please contact : Name /Name Relationship Relationship Start Date: Date of Birth: Phone Phone This Information is for your safety and the safety of others M EFTA_00 192987 EFTA01304175