This form is used to report any work-related incident, injury, near-miss, or safety concern that occurs during an assignment or while representing RISE. Submitting this report helps us document what happened, follow up appropriately, and work with the site to prevent future incidents. Please provide as much detail as possible (who, what, when, where, and how), including any witnesses and actions taken on-site. If this is an urgent medical or safety emergency, contact 911 and notify your on-site supervisor immediately, then submit this form as soon as you are able.