DOT Physical/Drug Screen Form - Heartland Community College
DOT Physical/Drug Screen FormI,, am to take a DOT physical and drug screen at OSF Occupational Health at St Joseph Medical Center.I understand that it is my responsibility to have an acceptable DOT physical and drug screen report from OSF Occupational Health prior to being enrolled in Heartland’s CDL class. I also understand that I am responsible for the entire cost of the physical and drug screen.I hereby authorize OSF Occupational Health to disclose my full DOT physical and drug screen results to Heartland Community College at the address below. These are pre-registration test results as required by the Secretary of State of Illinois.Student’s SignatureDateInformation regarding your DOT physical.OSF Center for Health - Occupational Health210 St. Joseph Drive309-661-6270You must make an appointment.You must have a Photo ID.ATTENTION: OSF Occupational HealthPlease send all DOT physical and drug screen test results for the above student to:Laurie MuellerTruck Driver TrainingHeartland Community College1500 W Raab Rd Normal, IL 61761If you have questions or need additional information, Please contact our office at (309) 268-8448. ................
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