The purpose of this study was to identify and describe fatal occupational injuries using a medical examiner (ME) database and to assess the usefulness of this database as part of a surveillance system for fatal occupational diseases. Cases included in this study had to meet the following criteria: result from traumatic injury while at work in North Carolina; must have occurred in the period January 1, 1978 through December 31, 1984; worker must have been at least 16 years of age; manner of death was determined accidental or homicide (unless the victim and perpetrator were acquainted) by investigating ME; victim was not recorded occupationally as a student, housewife, or retired; and the industry must not be military. These criteria allowed the inclusion of 1233 deaths in this study, 1091 to state residents. Women accounted for 44 of these 1091 deaths with the most frequent manner being homicide. For the men, homicide accounted for only 15 percent of all deaths in men. Unintentional injury death rates were 23 times higher in men as compared to women. Older age groups suffered a general increase in fatal injury rates. For women the industry with the highest overall rate for fatal injury was agriculture with the trade industry having the highest homicide rate. For men the highest fatality rates were in forestry/fishery, agriculture, construction, and transportation/public utilities/communications with the highest homicide rate being in trade. More injuries occurred during the warm weather months. The leading means of deaths was motor vehicle incidents, 21 percent. Guns were the second most frequent means of death, followed by falls and falling objects. Of the 813 cases tested for alcohol, negative results were obtained 89 percent of the time.