EFTA00003050.pdf
470 KB
Extraction Summary
1
People
2
Organizations
1
Locations
0
Events
1
Relationships
1
Quotes
Document Information
Type:
Emergency contact form / employee record
File Size:
470 KB
Summary
An Emergency Contact Form for LSJE, LLC dated October 18, 2018. The form identifies Donald Pollon as the employee, but the majority of the personal information fields (address, medical info, etc.) are left blank. The specific emergency contact names and numbers at the bottom of the form have been redacted.
People (1)
| Name | Role | Context |
|---|---|---|
| Donald Pollon | Employee |
Listed as the employee on the LSJE, LLC Emergency Contact Form.
|
Organizations (2)
| Name | Type | Context |
|---|---|---|
| LSJE, LLC |
Employer/Company issuing the form.
|
|
| The Saint James Group |
Implied by the email address 'thesaintjames.group@gmail.com'.
|
Locations (1)
| Location | Context |
|---|---|
|
Address listed for LSJE, LLC.
|
Relationships (1)
Donald Pollon listed as 'Employee Name' on LSJE, LLC form.
Key Quotes (1)
"This information is for your safety and the safety of others."Source
EFTA00003050.pdf
Quote #1
Full Extracted Text
Complete text extracted from the document (906 characters)
LSJE, LLC
6100 Red Hook Quarters, Suite B-3, St. Thomas, VI 00802-1348
Phone [REDACTED] E-mail: thesaintjames.group@gmail.com
6100 Red Hook Quarters, Suite B-3, St. Thomas, VI 00802-1348
Phone [REDACTED] E-mail: thesaintjames.group@gmail.com
Emergency Contact Form
Today's Date: 10/18/18
Start Date: [BLANK]
Employee Name: Donald Pollon
Date of Birth: [BLANK]
Physical Address: [BLANK]
Mailing Address: [BLANK]
Cell Phone: [BLANK]
Phone (other): [BLANK]
E-mail: [BLANK]
Marital Status: [BLANK]
Title/Position: [BLANK]
Driver's License No: [BLANK]
Start Date: [BLANK]
Employee Name: Donald Pollon
Date of Birth: [BLANK]
Physical Address: [BLANK]
Mailing Address: [BLANK]
Cell Phone: [BLANK]
Phone (other): [BLANK]
E-mail: [BLANK]
Marital Status: [BLANK]
Title/Position: [BLANK]
Driver's License No: [BLANK]
Allergies or Health Concerns: [BLANK]
Blood type:
[ ] A- [ ] A+ [ ] AB- [ ] AB+ [ ] B- [ ] B+ [ ] O- [ ] O+ [ ] Unknown
Blood type:
[ ] A- [ ] A+ [ ] AB- [ ] AB+ [ ] B- [ ] B+ [ ] O- [ ] O+ [ ] Unknown
Current Medications: [BLANK]
Doctor's Name: [BLANK]
Doctor's Phone: [BLANK]
Doctor's Name: [BLANK]
Doctor's Phone: [BLANK]
Doctor's Name: [BLANK]
Doctor's Phone: [BLANK]
Doctor's Name: [BLANK]
Doctor's Phone: [BLANK]
In case of emergency, please contact:
Name: [REDACTED]
Relationship: [BLANK]
Phone: [REDACTED]
Name: [REDACTED]
Relationship: [BLANK]
Phone: [REDACTED]
Name: [REDACTED]
Relationship: [BLANK]
Phone: [REDACTED]
Name: [REDACTED]
Relationship: [BLANK]
Phone: [REDACTED]
This information is for your safety and the safety of others.
EFTA00003050
EFTA00003050
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