Background: In 1991, NIOSH established the Alaska Field Station in collaboration with the Alaska Department of Health and Social Services, to prevent work-related deaths. Working through partnerships and by applying the public health model, Alaska experienced a 49% decline in work-related deaths from 1990 - 1999. Many of the hazards faced by Alaskan workers were exacerbated by the remoteness and cold environment. Additional prevention efforts have continued. Methods: The Alaska Occupational Injury Surveillance System was used to identify all fatal work-related traumatic injuries that occurred since 1999. Data are available on age, gender, occupation/industry, weather and circumstances of death. Results: During 2000 - 2009, there were 379 occupational fatalities in Alaska. This is a decrease of 41.5% from the previous decade. The occupations accounting for the highest number of fatalities continued to be commercial fishermen (111, 29%) and pilots (47, 12%). The most common events or exposures leading to fatalities also remained the same. They were related to vessels such as sinkings or falls overboard (128, 34%), aircraft crashes (87, 23%), contact with objects (46, 12%), vehicle crashes (35, 9%) and assaults (29, 8%). Conclusions: Although the occupations with the most fatalities and the events exposures leading to traumatic deaths have not changed from the decade of the 1990s to the 2000 - 2009 decade, there continues to be a substantial decline in the number of work related fatalities in Alaska. NIOSH has reported that fatality rates among crab fishermen have declined by 60% since 1999. Additionally, the aviation crash rate has declined by 34% since 2000. Interventions that have been developed in Alaska since 2000 include stability checks for the Bering Sea crab fleet, and the Capstone Program to improve aviation safety. Progress has been made, but there remains a need for continued safety interventions to combat the unique work hazards found in Alaska.