Occupational confined space fatalities in Virginia reported from 1979 to 1986 were investigated. There were 41 confined space accidents involving 50 fatalities. Confined space fatalities occurred in workers of all ages, especially between 30 and 49; the majority were male craftsmen, operators, or laborers. Only two cases showed evidence of alcohol intoxication. Five percent of the occupational fatalities in Virginia were related to confined space, especially in shipbuilding and repair facilities, local government, and other manufacturing facilities. Forty nine percent occurred on Thursday or Friday, and only one fatality occurred on a Monday. Multiple fatalities occurred in 10% of the accidents. There were three fatalities in rescuers, and many nonfatal injuries were also seen. Atmospheric conditions and fire/explosion were the leading causes of accidents and fatalities, usually due to oxygen deficiency (33%) or the presence of carbon-monoxide (630080) (20%). In six cases, a toxic gas or oxygen deficient atmosphere was generated or released by activity of the victim while in the confined space. Construction and manufacturing confined space accidents usually occurred in pressure vessels, stacks, boxcars, or machinery. Shipbuilding accidents usually occurred in ship compartments. The authors conclude that working in a confined space can be hazardous, and workers should be properly trained in specified precautions. They also suggest continuous monitoring of the confined space atmosphere, especially when there is a potential for atmospheric deterioration during occupancy.