The Certified Safe Farm (CSF) Project was developed at the University of Iowa in 1996 in order to address the high rates of fatalities, injuries, and fam1-related illnesses in the agricultural population. This multi-component, voluntary program consists of an agricultural occupational health screening conducted at an AgriSafe Clinic, general preventive health education and fit-testing of personal protective equipment, and an on, fam1 safety review. An intervention group began receiving the above services on a yearly basis in 1998. To test the effectiveness of the program, fam1-related injuries, illnesses, and fatalities were tracked in the intervention group and in a control group through self-reports made on a yearly demographic information form and via a quarterly telephone questionnaire that occurred over a three-year time period. This self-reported data was analyzed for evidence that the CSF program reduced the number and costs associated with agricultural injuries and illnesses in the fam1ers who received the services. In addition to reducing illnesses, injuries, and fatalities in participating fanners, CSF was designed with a built-in reward system that provides incentives to farmers who participate and sponsors who support the program. Because the majority of family fanners purchase individual health insurance coverage, and because they engage in a high-risk occupation, fanners often spend much of their disposable income on monthly premiums and out-of-pocket medical expenses. Health insurance costs continue to increase to levels that put a strain on the financial stability of farm families, notwithstanding the effect these costs have on access to preventive care. Farmers must also pay premiums for crop insurance, property/casualty insurance, and liability coverage, to name a few. Fanners who meet specified CSF standards of health and safety receive incentives for certification, with cash incentives having been awarded in the past. Now, through collaboration with a key health insurer in Iowa, CSF effectiveness will be tested by analyzing claims data. If claims are found to be lower in certified CSF fanners, future incentives may be subsidized through lower premiums on health, property/casualty, and liability insurances for fanners. Agribusinesses will also support the program by providing discounts on implement and seed/feed costs, in exchange for promotion of their products and services and a safer and healthier customer base. This reward system is what makes CSF different than other incentive programs: CSF will be replicated and sustained by agribusinesses and insurers in the communities where farmers live and work. Preliminary findings from focus groups, telephone calls, and personal conversations show that the program is welcomed and appreciated by farmers who would not ordinarily receive the services provided through the program. Farmers see this outreach program as something that is necessary and worthwhile. Health and safety indicators have shown improvements in the areas of machinery safety, respiratory personal protective equipment use, self-reported illness and injury medical costs, and occupational disease-related respiratory symptoms. Participating farmers have improved their farm review scores over the five years of the project, with scores averaging 82% (a passing score requires an 85%) in 1998-99, and increasing to 97% in 2002-2003. These improvements not only indicate the ongoing effort of the farmers to continue making safety improvements over time, but it has also been shown that the on- farm safety reviewers have made concerted efforts to assist the farmers in making these improvements. The occupational health screenings, demographic information forms, and quarterly calls have shown that self-reported, farm-related illness and injury costs were lower in intervention farmers at a rate of $90/person/year .In addition, use of respiratory personal protective equipment (PPE) increased significantly in intervention farmers. Support of the CSF program has been expressed in many ways: through the retention of enrolled farmers and their expression of appreciation and value in the program, through the dissemination of the key concepts of the program to rural AgriSafe health clinics throughout the state of Iowa, through multiple newspaper and farm journal publications, and through the support of key funders and business entities in the state of Iowa and in the nation, including: NIOSH, Iowa Pork Producers, National Pork Producers, Wellmark Foundation, Pioneer Hi-Bred, AgriSafe Network, and recently, Iowa Farm Bureau Federation and Wellmark Blue Cross Blue Shield of Iowa, a key health insurance organization in the state that provides insurance coverage to 40% of all Iowans.