On October 18, 1999, a 33-year-old female highway construction laborer (the victim), was struck and killed by a truck while flagging traffic. The victim was struck from behind by a 10-ton straight-side produce truck. Prior to the incident, the victim (Flagger 1) was on the south side of the highway facing west with her flag, preparing to stop all eastbound traffic on the highway. Another flagger (Flagger 2) was on the north side of the highway, approximately 50 feet east of the victim, and was stopping westbound traffic. Flagger 2 signaled the westbound produce truck to stop and the truck had almost come to a complete stop when a westbound tractor trailer approached at approximately 55 miles per hour and struck the produce truck in the right rear. The produce truck was struck with such force that it was momentarily airborne and the driver could not control his vehicle; the produce truck was propelled across the eastbound lane directly into the path of the victim, who was still facing west with her back to the oncoming truck. Flagger 2, on the north side of the road, was able to jump clear of the impacting trucks. He was unable to see or warn the victim. Fire rescue personnel arrived within minutes, followed by the arrival of an aeromedical helicopter. The victim was pronounced dead at the scene. The driver of the tractor trailer was also injured and transported by helicopter to a trauma center. The driver of the produce truck was uninjured. Investigators concluded that, to help prevent similar occurrences, employers/highway construction contractors should: 1) consider the use of additional warning signs and traffic control devices to supplement the minimum signs recommended by the Manual on Uniform Traffic Control Devices (MUTCD); 2) provide and require use of hand-held or other portable radio communications equipment by flaggers at all times. Additionally, NIOSH recommends that; 3) state highway authorities should consider the use of law enforcement officers in cruisers at each end of large highway construction work zones and the use of radar surveillance for traffic speed control; 4) state highway authorities reduce speed limits in construction work zones on high-traffic-density highways to a maximum of 45 mph.