An analysis of fatal injuries in the United States (US) construction industry was performed. The records of the National Traumatic Occupational Fatality (NTOF) database were searched to identify all fatal accidents that occurred in the US construction industry from 1980 through 1985. NTOF was a death certificate surveillance system that was started by NIOSH in 1980 to record all deaths in US workers 15 years or older who died from a work related traumatic injury. Details of each identified fatal accident were reviewed. A total of 6,470 fatal injuries in US construction workers were reported to the NTOF system during the 6 year period. This amounted to an annual average of 1,078 deaths and represented an annual average incident rate of 25.8 deaths per 100,000 workers (death/100000). This incidence rate was far greater than the average annual rate for all US industries combined, 7.8 death/100000. Less than 1% of the victims were females. About 50% of the victims were under the age of 35 years, and 82% were nonHispanic white, 9% were black, and 6% were Hispanic. Forty eight percent of the deaths occurred to skilled craftsmen and related workers, 28% occurred to construction laborers, 11% to transportation operatives, and 5% to managers and contractors. Across all occupational groups, falls were the leading cause of fatal injury, accounting for 26% of the deaths. Other leading causes of death were electrocutions, machinery related injuries, motor vehicle accidents, blunt force injuries, and submersion or suffocation (submersion/suffocation), which accounted for 15.3, 13.0, 12.8, 10.4, and 5.5% of the deaths, respectively. Many of the blunt force and submersion/suffocation deaths resulted from collapsing materials and trench or excavation cave/ins. The authors conclude that the NTOF database has started to identify risk factors for fatal traumatic injuries in the US construction industry.