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

Employee Workers Comp Form

Employer’s First Report of Injury

If employee needs medical treatment, please send them to:

OSF Occupational Health Clinic

719 WM Kumpf Blvd

Peoria, IL 61605


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.