LJC Emergency Contact Change Authorization
Please complete this form for any changes to the emergency contact for your company.
New Emergency Contact
New Emergency Contact Work Phone Number
New Emergency Contact Cell Phone Number
New Emergency Contact Email
Authorized By (Primary Contact):
Delete the current Emergency Contact? If yes, please list the name(s) to delete.
These individuals will be contacted in the event of a bona fide building emergency. Please notify our office immediately of any changes in the above listed names.
Do Not Fill This Out