During 2003-2010, the U.S. oil and gas extraction industry (onshore and offshore, combined) had a collective fatality rate seven times higher than for all U.S. workers (27.1 versus 3.8 deaths per 100,000 workers). The 11 lives lost in the 2010 Deepwater Horizon explosion provide a reminder of the hazards involved in offshore drilling. To identify risk factors to offshore oil and gas extraction workers, CDC analyzed data from the Bureau of Labor Statistics (BLS) Census of Fatal Occupational Injuries (CFOI), a comprehensive database of fatal work injuries, for the period 2003-2010. This report describes the results of that analysis, which found that 128 fatalities in activities related to offshore oil and gas operations occurred during this period. Transportation events were the leading cause (65 [51%]); the majority of these involved aircraft (49 [75%]). Nearly one fourth (31 [24%]) of the fatalities occurred among workers whose occupations were classified as "transportation and material moving." To reduce fatalities in offshore oil and gas operations, employers should ensure that the most stringent applicable transportation safety guidelines are followed. CFOI, a cooperative program between the BLS and state governments, is the most comprehensive national surveillance system for work-related fatalities in the United States. Multiple data sources are used to collect information on each fatality. A fatal injury is considered work-related if the event leading to the injury occurred while the employee was working, based on confirmation by two independent sources. The oil and gas extraction industry includes three types of companies, defined according to the North American Industry Classification System (NAICS): oil and gas operators who control and manage leased areas (NAICS 211), drilling contractors who drill the wells (NAICS 213111), and well-servicing companies who provide all other types of support operations that prepare a well for production and completion (NAICS 213112). Offshore oil and gas operations include all activities involved in the extraction of crude oil and natural gas from reservoirs found beneath the seafloor. CFOI does not include a variable to specifically identify offshore fatalities. Further, not all workers involved in offshore operations are directly employed in the oil and gas extraction industry, and therefore would not be captured in one of the three NAICS codes above. To accurately identify all workers killed during offshore oil and gas operations, CDC and BLS identified cases two ways: 1) the fatality was included in one of the industry's three NAICS codes, and the CFOI variable denoting the location was coded as a body of water, or 2) the fatality contained any one of the following key words in the CFOI narrative: "offshore," "off shore," "platform," "boat," "ship," "barge," or "helicopter," and further examination of the case revealed that the incident was related to offshore oil and gas operations. Cases identified during 2003-2010 were analyzed by year, age, race/ethnicity, event type, nature and source of injury, and NAICS code. CFOI narrative data were reviewed to identify factors involved in helicopter events. Annual fatality rates were calculated using a count of active offshore drilling rigs as the denominator, which included fixed and semisubmersible drilling rigs, mobile offshore drilling units, and drillships. A Poisson regression model was used to measure trends. During 2003-2010, a total of 128 fatalities occurred in activities related to offshore oil and gas operations in the United States, an average of 16 per year. All but one fatality occurred in Gulf of Mexico operations. All decedents were male with a mean age of 41.4 years. The majority were non-Hispanic whites (101 [79%]). Despite a 63% decrease in the number of active offshore drilling rigs during 2003-2010, the number of annual fatalities during offshore operations remained stable, resulting in a statistically significant increase in the number of fatalities per rig rate. Transportation events were the leading cause of fatalities (65 [51%]), followed by contact with objects or equipment (21 [16%]), fires and explosions (17 [13%]), and exposure to harmful substances/environments (16 [13%]). Seventy-five percent of transportation events were associated with aircraft, all of which were helicopters (49 fatalities). Seventeen helicopter events occurred; 11 of these resulted in 43 (88%) of the fatalities. CFOI narratives noted that mechanical failure or loss of engine power was associated with five events (eight fatalities), and bad weather played a role in three of the events (seven fatalities). In five events, a total of nine fatalities involved occupants who survived the initial impact but later drowned. All of the helicopter events occurred in Gulf of Mexico offshore operations. Two thirds of the fatalities involved workers employed in the oil and gas extraction industry (87 [68%]). Of those, half involved workers employed by well servicing companies (43 [49%]), followed by drilling contractors (26 [30%]), and oil and gas operators (18 [21%]). The remainder involved workers in offshore oil and gas operations who were classified as employees in another industry, including transportation and warehousing (23 [18%]), construction (10 [8%]), and all other industries (eight [6%]). Nearly one fourth (31 [24%]) of the decedents worked in occupations classified as "transportation and material moving" that transported workers and their equipment to and from offshore drilling platforms.