The surveillance of occupational illness and injury is reviewed, gaps in current surveillance programs are identified, and the future directions of occupational surveillance are indicated. Topics discussed include: the essential purposes and characteristics of occupational surveillance; surveillance targets; limitations and applicability of the communicable disease surveillance model; contrasts between injury and illness surveillance; the usefulness and limitations of current data sources for health effects surveillance (direct medical surveys, employee generated records, workers' compensation data, laboratory data); and current data sources for hazard surveillance (OSHA inspection records, direct hazard survey). An overview of current surveillance activities at the federal and state levels is presented. Standardization of surveillance data collection, improvement of exposure assessment, local surveillance centers and provider reporting networks, and the central coordination of surveillance activities were considered. Future surveillance activities were discussed and included a survey standardization project and a sentinel event notification system for occupational risks.