On December 4, 2001, a 54-year-old male construction laborer (the victim) was fatally injured when he was run over and crushed by a motor grader (hereafter termed grader). At the time of the incident, the grader operator was driving the grader in reverse on a road under construction in a housing development. The victim and a coworker were standing in the road at the rear of their parked pickup truck discussing the next stage of their work when the grader operator began backing in their direction. The coworker saw the grader backing toward them and yelled to the operator to stop. The operator did not hear the warning. The back tire of the grader struck the victim, knocking him down. The operator stopped the grader when it struck the rear of the parked pickup truck. The victim was under the rear tire of the grader. The coworker told the operator to pull forward and then called 911 on his cell phone. Emergency medical services (EMS) and police personnel responded within minutes. Emergency care was initiated by EMS personnel and the victim was transported to an area hospital where he died approximately 90 minutes after the incident. NIOSH investigators concluded that, to help prevent similar occurrences, employers should: 1) develop, implement, and enforce a comprehensive written safety program for all workers which includes training in hazard recognition and the avoidance of unsafe conditions; 2) conduct a prework safety meeting each day to discuss the work to be performed, potential safety hazards and safe work procedures, and means to be used for communicating changes to the work plan; 3) ensure that equipment is inspected daily and all defective equipment is removed from service until needed repairs have been made; 4) ensure that required personal protective equipment is provided and used in accordance with company policy; 5) consider installing strobe lights on company-owned pickup trucks used on road construction sites Additionally; 6) manufacturers of heavy equipment, such as graders, should explore the possibility of incorporating collision avoidance technology on their equipment.