Date
Employee Name / Date of Birth
Type of Service / Treatment ofWork Related Injury / Illness / Evaluation of Work Related Injury/ Illness (if required by WC)
Company Name / ILLINOISSTATEUNIVERSITY
Company Address / Campus Box 1320, 202 NSB
City / Normal / State / IL / Zip / 61790
Supervisor orAppointedIndividual Authorizing Fiscal Responsibility:
Print Name Here / Phone
Signature
OSF St. Joseph Treatment Hours and Locations
/ Occupational Health Center
1505 Eastland Dr.
Normal , IL61761
Phone (309)661-6270 / Prompt Care
2200 Ft. Jesse Road, Suite 100
Normal , IL 61761
Phone (309)661-6280 / Prompt Care
1505 Eastland Dr
Bloomington , IL61704
Phone (309)663-2100 / St. JosephMedicalCenter
2200 E. Washington St.
Bloomington , IL61701
Phone: (309)662-3311
Monday - Friday / 8:00 am - 5:00 pm
Monday - Saturday / 8:00 am - 7:00 pm / 8:00 am - 7:00pm
Sunday / 8:00 am - 6:00 pm / 8:00 am - 6:00 pm
Sunday-Saturday
(7 days/week) / 24 Hours/day
Directions to OSF Facilities
To The Center For Health at Ft.Jesse:(2200 Ft. Jesse Road, corner of Ft. Jesse Road and Halsted Drive)
From OSF St. Joseph Medical Center
Veterans Parkway north to Ft. Jesse Road
Ft. Jesse Road east (right) to Halsted Drive
I-55 south (from Joliet/Pontiac/Towanda)
Exit Bloomington/Veterans Parkway to Ft. Jesse Road
East (left) on Ft. Jesse Road to Halsted Drive
I-55 north (from St. Louis/Springfield/Lincoln)
Exit Veterans Parkway north to Ft. Jesse Road
East (right) on Ft. Jesse Road to Halsted Drive
I-74 east (from Peoria/Morton/Mitsubishi Motorway)
Exit I-74/I-55 north to Veterans Parkway
Exit Veterans Parkway to Ft. Jesse Road
East (left) on Ft. Jesse Road to Halsted Drive
I-74 west (from Champaign/LeRoy/Downs)
Exit I-74/I-55 north to Veterans Parkway
Veterans Parkway north to Ft. Jesse Road
East (right) on Ft. Jesse Road to Halsted Drive
I-39 south (from Rockford/LaSalle-Peru/Minonk)
Exit I-55 north to Veterans Parkway
Exit Veterans Parkway to Ft. Jesse Road
East (left) on Ft. Jesse Road to Halsted Drive / To the MedicalCenter:
OSFSt.JosephMedicalCenter is conveniently located at 2200 East Washington Street, Bloomington, on Veterans Parkway between Eastland Mall and State Farm Corporate Headquarters. It is easily accessible from I-74, US 55, Route 9, US 150 and I-51.
From the north, (Joliet/Pontiac/Towanda) take US 55 south to the Business 55 (Veterans Parkway) exit. Go south to Eastland Drive and turn right (west). The medical center is on the left. OR from Rockford/LaSalle-Peru/Minonk, take I-39 south. Go north on US 55 to the Business 55 (Veterans Parkway) exit. Go south to Eastland Drive and turn right (west).
From the south, (St. Louis/Springfield/Lincoln) take US 55 north to the Business 55 (Veterans Parkway) exit. Go north to Eastland Drive and turn left (west). The medical center is on the left.
From the west, (Peoria/Morton/Mitsubishi Motorway) take 74 east to the Business 55 (Veterans Parkway) exit. Go north to Eastland Drive and turn left (west). OR take Route 9 (Market Street) east to Center Street and turn right (south). Turn left on Washington Street (east) and go three miles. OSF St. Joseph is on the left.
From the east, (Champaign/LeRoy/Downs) take I-74 west. Exit on I-74/US 55 and go north on Business 55 (Veteran's Parkway). Turn left (west) on Eastland Driveand the medical center is on the left.