ACCIDENT FORMS

Injuries need to be reported to the supervisor as well as the HR department within 24 hours of the event.

Employee Workers Comp Form

Employer’s First Report of Injury

If an employee needs medical treatment, please send them to:

OSF Occupational Health Clinic
719 WM Kumpf Blvd
Peoria, IL 61605
309-624-8525
Hours: 6:30 am – 5:00 pm    Monday – Friday

Please send them with this Insurance Information Form that provides our insurance information to the healthcare facility.

If the person is NOT an employee of South Side Mission, please fill out Notice Of Injury Volunteer or Other.

If you have any questions, please contact Human Resources at extension 2104.