State Occupational Safety & Health Surveillance Program

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Each year, millions of workers in the United States are injured on the job or become ill because of exposure to health hazards at work. In 2019 there were 5,333 fatal work injuries recorded in the United States, a 2 percent increase from the 5,250 in 2018, according to the Census of Fatal Occupational Injuries Summary. Although deaths from work-related illnesses are more difficult to count, a 2011 publication estimated that 53,445 work-related deaths occur annually.

In 2020, the U.S. Bureau of Labor Statistics indicated that employers reported approximately 2.7 million nonfatal work-related injuries and illnesses to private industry workers. Work-related injuries and illnesses result in substantial human and economic costs for workers, families, employers, and society. A 2011 publication estimated that the direct and indirect costs of work-related injuries and illnesses exceed $250 billion annually.

Work-related injuries and illnesses can be prevented, and successful approaches to making workplaces safer and healthier begin with having the data necessary to understand the problem. As part of its mission to prevent work-related injuries, illnesses, disabilities, and fatalities caused by hazards in the workplace, NIOSH funds states and other jurisdictions to conduct occupational safety and health (OSH) surveillance to assess the extent and severity of workplace injury, illness, disability, and death and identify worker populations and occupations at greater risk.  This information can be used to: 1) set program priorities to address new and emerging issues, 2) develop workplace interventions, and 3) create links to policy initiatives that may improve worker safety and health in their state and measure the effectiveness of those actions.

State Role in Occupational Safety and Health Surveillance

For more than 40 years, NIOSH has recognized the key importance of state public health approaches to addressing occupational health problems. The institute began funding pilot surveillance programs in a limited number of state health departments in the 1970’s. State public health agencies have a critical and complementary role in the prevention of occupational injuries, illnesses, disabilities, and fatalities, and these agencies are uniquely positioned to use state-specific data sources and link surveillance findings with intervention outreach activities within their jurisdictions.

NIOSH has funded a variety of approaches to build state capacity in OSH, ranging from the development of population-based and case-based surveillance systems, to creating focused public health interventions that address the OSH needs of high-risk populations such as minorities and teen workers. State programs demonstrate that effective surveillance of occupational injuries, illnesses, disabilities, and death embraces the concept of “information for action” by ensuring that collection, analysis, interpretation, and dissemination of health data are linked to prevention and control activities. In addition, state surveillance systems and activities provide a vital foundation for several federal surveillance systems and augment others.

NIOSH has used cooperative research agreements to fund approximately 10 state surveillance programs since 2000, and by 2009, the number of funded states increased from 15 to 23. NIOSH has provided financial and technical assistance to state health and labor agencies to develop or expand state surveillance program capacity and technical infrastructure. Examples include the addition of epidemiologists and other technical staff, training and continuing education, informatics or methods improvements, contracting for specialized statistical and communications expertise, and purchase of statistical software.


The primary purpose of NIOSH’s state surveillance program is to provide financial and technical support to states and other eligible jurisdictions for the development or expansion of an OSH surveillance program. Through this program, NIOSH seeks to strengthen OSH surveillance within states and other eligible jurisdictions that will provide information that will help drive actions to improve the health of workers in the United States.

NIOSH supports the use of existing surveillance data and the collection of new surveillance data to better define the current health of the state’s workforce, target relevant worker populations at risk, develop relevant interventions, and initiate and enhance partnerships within, and beyond, the state’s surveillance community. NIOSH also supports the advancement of state surveillance systems to enable the future use of new or newly emerging electronic surveillance data sources and to participate in the development of the data sources and data exchange methods. NIOSH strongly encourages state surveillance programs to engage directly in activities and initiatives related to the collection, exchange, and use of electronic health data.

States are expected to be innovative in the dissemination and communication of products that they develop. Whenever possible, communication products should inform measurable surveillance data findings and related public health actions that include recommendations for prevention, interventions, policies, and communications that advance the integration of proven health and safety strategies into targeted workplaces by organizations both within and outside of traditional occupational health. A key goal is to build partnerships among surveillance programs and health agencies, and other organizations and stakeholders that engage in OSH surveillance or can be leveraged to improve surveillance.

NIOSH expects state surveillance programs to do the following:

  • Identify, access, and analyze data that can be used to conduct surveillance of work-related injuries, illnesses, exposures, and fatalities.
  • Use findings for the calculation of incidence and/or prevalence of occupational injuries, illnesses, exposures, and fatalities, including calculation of occupational health indicators (OHIs).
  • Be resourceful and proactive in identifying and accessing untapped data sources for surveillance, which may include creating linkages between data sources.
  • Identify surveillance trends, emerging issues and diseases, high-risk occupations, industries, and worker populations.
  • Establish and address state priorities for follow-up activities, including more in-depth data surveillance and outreach, prevention, and intervention programs.
  • Establish and maintain an advisory committee, or other process(es) to obtain stakeholder input and identify relevant state-specific issues and priorities.
  • Apply current technologies to develop and communicate audience-specific educational materials, outreach, and other resources for optimizing their uptake, adoption, or adaptation for protecting workers.
  • Find ways to foster the integration of OSH into broader public health goals and objectives (such as infectious and chronic disease).
  • Develop workplace interventions and create links to policy initiatives that may improve worker health and safety in their state.

Current Funding Cycle

The program’s current funding cycle includes 22 awards, funded from 2021-2026, and consists of 3 Fundamental, 6 Fundamental-Plus, and 13 Expanded Programs. Additional rounds of competition in 2022 and 2023 may add more programs.

Fundamental Programs establish and maintain “fundamental” OSH surveillance capacity and conduct activities to do the following:

  • Use available data sources to generate a state employment profile of the employed workers in the state.
  • Collect, analyze, and interpret a minimum of 15 of 25 OHIs annually.
  • Use OHIs to identify and prioritize the state’s occupational health burden and needs and conduct follow-up prevention activities such as investigations, interventions, or policy/rule changes for high priority issues in their state.
  • Participate in the NIOSH Adult Blood Lead Epidemiology Surveillance System to conduct annual follow-back/intervention/communication activities for work-related adult blood lead cases based in case load.
  • Engage in activities and initiatives related to the collection, exchange, and use of electronic health data by promoting inclusion and analysis of industry and occupation work variables in existing data collection and maintaining awareness of the status of electronic case reporting within the state.
  • Build and maintain meaningful collaborations and partnerships that will improve state surveillance activities.
  • Include efforts to address worker groups that are underserved in their state.
  • Identify intended audiences and stakeholders for dissemination of surveillance findings and tailor communication products to those groups.

Fundamental-Plus Programs conduct all fundamental activities (mentioned above) plus two projects: (1) an in-depth or follow-back investigation activity based on findings from surveillance data analyses or OHIs; and (2) a policy or intervention activity in collaboration with state partners, other state grantees, or other external partners that can impact the surveillance of an identified occupation, industry, or population.

Expanded Programs conduct all fundamental activities (mentioned above) plus they conduct in-depth surveillance activities in up to four priority areas of their choosing. Expanded Programs are expected to identify and access data beyond those available from national OSH surveillance systems and to articulate the need for proposed activities for each of the proposed priority areas.

These 22 state surveillance programs are managed by 13 state health departments (59%), 2 state Departments of Labor (9%), and 7 bona fide agents (32%), which involve partnerships between state health departments and universities. These programs reside in states that contain about 64% of the civilian labor force and include 18 of the 29 most populated states in the United States. The portfolio includes approximately 37 surveillance projects that include topics such as respiratory diseases, pesticide poisonings, worker fatalities, opioids, heat-related illnesses, motor vehicle injuries, infectious diseases, and healthcare workers.

NIOSH Sponsored State Occupational Health Safety Surveillance Program 2019

State Program Descriptions

NIOSH State Surveillance Program Focus on Timely COVID-19 Related Projects

During fiscal year (FY) 2021, NIOSH provided extramural funding for projects that address challenges related to the coronavirus disease 2019 (COVID-19). This included one year of funding provided through the Centers for Disease Control and Prevention’s (CDC) COVID-19 response efforts for NIOSH’s state surveillance program. Fifteen of the 22 NIOSH-funded states requested and received funding for 26 projects focused on either one or both of two areas: (1) worker safety and health support, safe return to work policies, and mitigation or prevention of COVID-19 outbreaks in various industrial sectors, or (2) strengthening vaccine confidence in workers. These projects are described below.

Support for Worker Safety and Health, Safe Return to Work Policies, and Mitigation or Prevention of COVID-19 Outbreaks in Various Industrial Sectors

Support for Vaccine Confidence in Workers

Fiscal Year (FY) Extramural Research Program Highlights

Program achievements featured in the Extramural Research and Training Program Annual Reports

Funding Opportunity Announcements

All cooperative agreement funding opportunity announcements can be found at:

Page last reviewed: January 27, 2021