Death on the Job: The Toll of Neglect, 2023

This 2023 edition of Death on the Job: The Toll of Neglect marks the 32nd year the AFL-CIO has produced a report on the state of safety and health protections for America’s workers. The Occupational Safety and Health Act, promising every worker the right to a safe job, has been in effect for more than 50 years, and more than 668,000 workers now can say their lives have been saved since the passage of the OSH Act.

Over the last 50 years, there has been significant progress toward improving working conditions and protecting workers from job injuries, illnesses and deaths. Federal job safety agencies have issued many important regulations on safety hazards and health hazards like silica and coal dust, strengthened enforcement and expanded worker rights. These initiatives have undoubtedly made workplaces safer and saved lives. But much more progress is needed.

Over the years, the progress has become more challenging as employers’ opposition to workers’ rights and protections has grown, and attacks on unions have intensified. Big corporations and many Republicans have launched an aggressive assault on worker protections. They are attempting to shift the responsibility to provide safe jobs from employers to individual workers, and undermine the core duties of workplace safety agencies.

The nation must remain committed to protecting workers from job injury, disease and death. Preventing injury, illness and death at work to restore dignity, save lives, improve livelihoods, and reduce burdens on families and communities must be a high priority. Employers must meet their responsibilities to protect workers and be held accountable if they put workers in danger. Only then can the promise of safe jobs for all of America’s workers be fulfilled. There is much more work to be done to ensure the fundamental right to a safe job is a reality for all.

The High Toll of Job Injuries, Illnesses and Deaths In 2021:

• 343 workers died each day from hazardous working conditions.
• 5,190 workers were killed on the job in the United States.
• An estimated 120,000 workers died from occupational diseases.
• The job fatality rate increased to 3.6 per 100,000 workers.
• Black workers died on the job at the highest rate in more than a decade.
• Latino workers continue to be at greater risk of dying on the job than all workers.
• Employers reported nearly 3.2 million work-related injuries and illnesses.
• The true impact of COVID-19 infections due to workplace exposures is unknown.
• Limited data show that more than 1.5 million nursing home workers have been infected with COVID-19 and more than 3,000 have died.
• Workplace violence, musculoskeletal disorders from repetitive motion injuries and occupational heat illness continue to be major problems, but data no longer is reported annually to track and understand these important issues.
• Underreporting is widespread—the true toll of work-related injuries and illnesses is 5.4 million to 8.1 million each year in private industry.

The cost of job injuries and illnesses is enormous—estimated at $174 billion to $348 billion a year.

States with the highest fatality rates in 2021 were:

• Wyoming (10.4 per 100,000 workers)
• North Dakota (9.0 per 100,000 workers)
• Montana (8.0 per 100,000 workers)
• Louisiana (7.7 per 100,000 workers)
• Alaska (6.2 per 100,000 workers)
• New Mexico (6.2 per 100,000 workers)

Industries with the highest fatality rates in 2021 were:

• Agriculture, forestry, and fishing and hunting (19.5 per 100,000 workers)
• Transportation and warehousing (14.5 per 100,000 workers)
• Mining, quarrying, and oil and gas extraction (14.2 per 100,000 workers)
• Construction (9.4 per 100,000 workers)
• Wholesale trade (5.1 per 100,000 workers)

Black and Latino workers are more likely to die on the job:

• The Black worker fatality rate of 4.0 per 100,000 workers increased sharply in 2021 from 3.5 in 2020; this rate is now the highest in more than a decade.
• 653 Black workers died on the job, the highest number in at least 19 years.
• The Latino fatality rate is still disproportionate to the overall job fatality rate, at 4.5 per 100,000 workers in 2021—25% higher than the national average, and marking a 13% increase over the past decade.
• The number of Latino worker deaths in 2021 increased slightly from the previous year: 1,130 deaths in 2021, compared with 1,072 in 2020. Of those who died in 2021, 64% were immigrants.

Older workers and minors are at high risk.

In 2021:

• More than one-third of workplace fatalities occurred among workers ages 55 and older.
• Workers 65 and older have 2.3 times the risk of dying on the job as other workers, with a job fatality rate of 8.4 per 100,000 workers.
• Many children, mostly migrants, have become the focus of stark exploitation, working in dangerous conditions.
• The number of children who died on the job in 2021 were 24 younger than 18 and 350 younger than 25 years old.

Job Safety Oversight and Enforcement

Occupational Safety and Health Administration (OSHA) resources in FY 2022 still are too few to be a deterrent:

• There are 1,871 inspectors (900 federal and 971 state) to inspect the 10.8 million workplaces under the Occupational Safety and Health Act’s jurisdiction.
• Federal OSHA has 145 additional inspectors than in FY 2021—but still only enough to inspect workplaces once every 190 years.
• There is one inspector for every 77,334 workers.
• The current OSHA budget amounts to $3.99 to protect each worker.

Penalties in FY 2022 still are too weak:

• The average penalty for a serious violation was $4,354 for federal OSHA.
• The average penalty for a serious violation was $2,221 for OSHA state plans.
• The median penalty for killing a worker was $12,063 for federal OSHA.
• The median penalty for killing a worker was $7,000 for state OSHA plans.
• Only 128 worker death cases have been criminally prosecuted under the Occupational Safety and Health Act since 1970.

Much Work Remains to Be Done Workers need more job safety and health protection, not less.

Action needed from job safety agencies:

• Fully enforce OSHA, Mine Safety and Health Administration (MSHA) and Environmental Protection Agency (EPA) job safety and health protections to hold employers accountable for not following workplace safety and health laws.
• Strengthen federal OSHA oversight of state OSHA plans.
• Increase attention to the significant safety and health problems faced by Latino, Black, immigrant and aging workers, and those under nontraditional work arrangements.
• Strengthen anti-retaliation protections and worker participation rights.
• Expeditiously issue a permanent OSHA COVID-19 standard to protect health care workers.
• Issue an OSHA workplace violence standard for health care and social service workers. Congress should pass legislation to ensure this is done.
• Issue an OSHA heat illness and injury prevention standard to protect indoor and outdoor workers from dangerously hot working conditions.
• Develop and issue new OSHA protections and initiatives to address emergency response, combustible dust and prevention of musculoskeletal disorders.
• Develop and issue an MSHA rule to protect miners from silica exposures and finalize MSHA protections on powered haulage equipment.
• Fully implement the Toxic Substances Control Act to protect workers from chemical exposures under EPA, in coordination with OSHA and the National Institute for Occupational Safety and Health.

Action needed from Congress:

• Increase funding and staffing at job safety agencies, modernizing the inadequate budget that has prevented agencies from fulfilling their obligations.
• Pass the Protecting America’s Workers Act to extend the Occupational Safety and Health Act’s coverage to workers currently excluded, strengthen civil and criminal penalties for violations, enhance anti-discrimination protections, and strengthen the rights of workers, unions and those who have been injured or made ill because of their jobs.
• Oppose attempts by corporations to weaken protections under the guise of regulatory “reform” that actually would make it more difficult—or impossible—for agencies to issue needed safeguards.

Action needed to restore and improve injury and illness data:

• Enhance access to timely injury and illnesses by providing the Bureau of Labor Statistics (BLS) additional resources to publish annual detailed nonfatal injury and illnesses data.
• Improve and restore the collection and reporting of demographic, cause, nature and other descriptive data for workers killed on the job through agreements and policies that allow BLS to publish more comprehensive worker fatality data.
• Strengthen the connection between major and emerging worker safety and health issues and data efforts needed to support the tracking and understanding of these key areas.
• Develop a national occupational disease surveillance system to determine and illuminate the true toll of occupational illnesses from workplace exposures, and inform prevention efforts to reduce chronic illnesses.

This 2023 edition of “Death on the Job: The Toll of Neglect” marks the 32nd year the AFL-CIO has produced a report on the state of safety and health protections for America’s workers. This report features national and state information on workplace fatalities, injuries and illnesses, as well as workplace safety inspections, penalties, funding, staffing and public employee coverage under the Occupational Safety and Health Act. It also includes information on the state of mine safety and health, and key topics such as COVID-19, workplace violence, musculoskeletal disorders and heat illness prevention.

Fifty-two years ago on April 28, the OSH Act went into effect, promising every worker the right to a safe job. More than 668,000 workers now can say their lives have been saved since the passage of the OSH Act. Since that time, workplace safety and health conditions have improved. But too many workers remain at serious risk of injury, illness or death as chemical plant explosions, major fires, construction collapses, infectious disease outbreaks, workplace assaults and other preventable workplace tragedies continue to occur. Workplace hazards kill and disable approximately 125,000 workers each year—5,190 from traumatic injuries, and an estimated 120,000 from occupational diseases. Job injury and illness numbers continue to be severe undercounts of the real problem. 

Over the years, our progress has become more challenging, as employers’ opposition to workers’ rights and protections has grown, and attacks on unions have intensified. Big corporations and many Republicans have launched an aggressive assault on worker protections. They are attempting to shift the responsibility to provide safe jobs from employers to individual workers, and undermine the core duties of workplace safety agencies. 

The Biden administration has taken important steps to protect workers, prioritizing worker protections on its regulatory agenda, taking steps on targeted enforcement efforts on urgent hazards, and filling staff and leadership vacancies. It also launched broad efforts on worker empowerment and targeting workplace inequities. Within the first two years, the Biden administration has been rebuilding the safety agency’s capacity and resources to hold employers accountable for providing safe workplaces. It has increased the number of inspectors, established strong enforcement initiatives, improved transparency and is working on new rules for worker participation of the Occupational Safety and Health Administration (OSHA) inspection process, and health and safety protections for workplace violence in health care and social assistance, heat illness prevention, silica in mining and injury tracking. 

This is a significant change from the Trump administration’s approach to safety and health, which rolled back progress made under the Obama administration, attacking longstanding workplace safety protections—targeting job safety rules on beryllium, mine safety examinations and injury reporting, and cutting agency budgets and staff—and attempting to dismantle the systems for future protections. The Trump administration totally failed to respond to the COVID-19 pandemic and the disparities of those most affected by work-related infection.

While the number of inspectors and inspections has improved in FY 2022—with 145 additional federal OSHA inspectors from the previous year—there is much more progress to be made to meet or exceed prepandemic levels. The COVID-19 pandemic also brought to light the weaknesses in federal oversight of state OSHA plans. Congress continues to fund job safety at stagnant levels, allowing an OSHA budget that still only amounts to $3.99 to protect each worker covered by the OSH Act. 

President Joe Biden has appointed strong candidates focused on worker protection to lead job safety and health agencies and labor agencies. Doug Parker has served as assistant secretary of labor for occupational safety and health—the head of OSHA—since October 2021. Previously, Parker served as the California OSHA chief, on the Biden-Harris transition team, in chief policy roles at the Mine Safety and Health Administration (MSHA) and was executive director of Worksafe—a nonprofit organization focused on workplace injury, illness and death prevention. Also in OSHA, President Biden appointed a longtime United Steelworkers (USW) safety and health leader, James Frederick, as deputy assistant secretary for occupational safety and health. As of April 2022, Christopher Williamson was confirmed and has served as assistant secretary of labor for mine safety and health. He previously served as a special assistant at MSHA in the Obama administration before serving as an attorney-adviser at the Federal Mine Safety and Health Review Commission. John Howard continues to serve as the head of the National Institute for Occupational Safety and Health (NIOSH).

In April 2021, the Senate confirmed Marty Walsh, the Boston mayor from the construction trades unions, as secretary of labor; he served until March 2023. President Biden then nominated the deputy secretary of labor and former secretary for the California Labor and Workforce Development Agency and the state’s labor commissioner, Julie Su, to replace Walsh. These appointments are a sharp contrast to President Donald Trump, who nominated corporate officials to head the job safety agencies—people who had records of opposing enforcement and regulatory actions, and who often lacked safety experience.

1 Calculated based on changes in annual fatality rates and employment since 1970. Fatality rate data for 1970 to 1991 is from National Safety Council Accident Facts, 1994. Fatality rate data for 1992 to 2021 is from the Bureau of Labor Statistics, Census of Fatal Occupational Injuries. Annual employment data is from the Bureau of Labor Statistics Current Population Survey. 

Over the more than 50 years since the passage of the OSH Act, there has been significant progress made toward improving working conditions and protecting workers from job injuries, illnesses and deaths, preventing devastating losses to working families and saving lives. Federal job safety agencies have issued important regulations on many safety hazards, as well as on silica, coal dust and other health hazards, strengthened enforcement and expanded worker rights. These initiatives undoubtedly have made workplaces safer and saved lives. But much more progress is needed.

The regulatory safety and health structural systems have been weakened over decades and are still under threat. Job safety agencies need to be rebuilt, not only restored to the pre-Trump era, but in ways that reflect solutions to the most significant barriers to ensuring workers are protected and can fully exercise their rights. This requires refocusing national attention, energy and action on the enormous role and impact these agencies play to provide workplace oversight and prevent the disease, injuries and death that plague working people across the country. After years of starved budgets, funding and staffing for job safety agencies, and decades of allocating an agency with an extensive mission—OSHA—too few resources, there must be new dedication to substantially increase resources to protect workers, and address ongoing and emerging safety and health problems.

Employers and elected leaders must recognize that employment is a significant determinant of health and take action and ownership to make workplaces safer. Severe inequities in dangerous working conditions have created an unacceptable discrepancy in those who face the largest burdens of disease, injury and death because of their jobs. Initiatives to address the safety and health risks posed by changes in the workforce and employment arrangements must take more prominence, and workplace safety and health regulations must be seen as a significant tool to raise the level of working conditions for those disproportionately affected. There must be renewed, dedicated attention given to the increased risk of fatalities and injuries faced by workers of color, immigrant workers, aging workers and young workers who are often exploited, and enhanced efforts to protect temporary and contract workers.

OSHA must immediately issue final and proposed rules that are currently under White House review, including a permanent standard to protect health care and other workers in congregate settings from COVID-19 and its standard on electronic injury reporting that will make more of the data collected public, and strengthen and fully enforce the anti-retaliation protections for workers who report injuries. 

Workplace violence is a growing and serious threat, particularly to women workers and those in the health care and social services sectors. OSHA must develop and issue a workplace violence standard, and the Senate should pass the Workplace Violence Prevention for Health Care and Social Service Workers Act to ensure this is done. OSHA also must move forward to issue proposed rules on heat illness prevention, emergency response and infectious disease. 

More attention and resources are needed to address health hazards in the workplace. OSHA standards for chemical hazards are obsolete and must be updated. The Environmental Protection Agency (EPA) must fully implement the new toxic chemicals reform law and coordinate with OSHA and NIOSH, taking action to address the risks to the public and to workers. New initiatives are needed to address musculoskeletal disorders and combustible dust.

The agency needs to fully enforce its standards and other workplace safety laws by developing a proactive enforcement plan across industries, fully investigating complaints, performing on-site inspections, issuing violations and penalties that reflect the size and scope of the real problem and deter other employers, and ensure workers’ rights to report unsafe working conditions and refuse dangerous work. Workers and their representatives must be able to fully participate in the enforcement process as employers and their representatives do. The Biden administration’s new OSHA enforcement initiative to encourage “instance-by-instance” citations to increase the penalty amounts to become a deterrent for willfully negligent employers is one step forward.

In mining, MSHA must continue initiatives to focus increased attention on mines with a record of repeated violations and stronger enforcement action against mines with patterns of violations. The agency must fully enforce the coal dust rule and act swiftly on new rules on silica and improving power haulage safety when working with mobile mining equipment. Congress must strengthen job safety laws to prevent tragedies like the Massey Upper Big Branch mining disaster, which killed 29 miners in West Virginia. Improvements in the Mine Safety and Health Act are needed to give MSHA more authority to shut down dangerous mines and to enhance enforcement against repeat violators.

The Occupational Safety and Health Act now is more than 50 years old and is out of date. Congress must pass the Protecting America’s Workers Act to extend the law’s coverage to workers currently excluded, strengthen civil and criminal penalties for violations, and strengthen the rights of workers and their representatives. Improvements to update and strengthen the OSH Act’s anti-retaliation provisions are particularly needed, so workers can report job hazards and injuries, and exercise safety and health rights without fear. 

The nation must remain committed to protecting workers from injury, disease and death. Preventing injury, illness and death at work to restore dignity, save lives, improve livelihoods, and reduce burdens on families and communities must be a high priority. Employers must meet their responsibilities to protect workers and be held accountable if they put workers in danger. Only then can the promise of safe jobs for all of America’s workers be fulfilled.

Throughout this report, there are notations where data have been restricted compared with past reporting. This has impacted the public’s understanding of key issues, worsening problems and attention needed to control hazards in the workplace. Annual reporting of these data helped employers, workers, advocates and the government analyze and evaluate trends in the workplace.

In 2020 (starting with 2019 data), the Bureau of Labor Statistics (BLS) updated its disclosure methodology policy, resulting in significantly fewer published descriptive data than had been reported. This has led to less transparency about a significant number of occupational deaths in the United States. 

There is now more limited information on the nature, events and sources of worker fatalities. Gender information no longer is reported for fatalities by cause (e.g., homicides, fires) and for workers by race (e.g., Latino workers). Country of origin is no longer reported for Latino workers and other workers by race. Occupation, industry and other information are no longer available for Latino immigrants and many other immigrant workers, despite fatalities among all foreign-born workers continuing to be a serious problem. On his first day in office, President Biden issued the Executive Order On Advancing Racial Equity and Support for Underserved Communities Through the Federal Government., More can be done to align this equitable lens with identification and reporting on occupational safety and health data that are leading to injuries, illnesses and deaths because of work. 

It is not just occupational fatality data that now are significantly limited. 

Data policies also have changed on the reporting of injuries that result in days away from work, collected through the BLS Survey of Occupational Injuries and Illnesses (SOII). BLS recently ended its pilot program on annual reporting and collecting data on days with job transfer or restriction case details for selected industries, resulting in a decision to report serious injuries only every two years instead of annually, and providing detailed data for both cases with days away from work (DAWF) and days of job transfer or restriction (DJTR) than in prior years. BLS made these changes after a 60-day request for comment on its information collection requests for workplace injuries and illnesses. Case and demographic estimates for DAFW and for DJTR cases will be produced biennially (every two years), starting with combined data from reference years 2021 and 2022 that will be published in the fall of 2023. BLS has made this policy change with the intention to remain resource neutral for the collection and reporting of data, and burden neutral for employers who report this injury and illness information. 

Therefore, we are not able to analyze and update our report’s data on some of these important topics this year. The only updated data available for 2021 include the rates and numbers of injuries and illnesses resulting in days away from work, restricted work activity, or job transfer and total injuries and illnesses overall and by detailed industry. Data have not been published for 2021 that provide information on worker characteristics, selected natures, parts of the body, events or exposure or occupation. This includes data on key topics like musculoskeletal disorders and serious injuries from workplace violence or heat overexposure.

BLS has stated that it plans to publish combined years of both cases with days away from work and cases with days of job transfer or restriction with the same level of detail previously provided only for cases involving days away from work. This could provide insights into a more complete understanding of the impact and nature of injuries among different worker populations, and better inform safety resources and return-to-work strategies. 

In recent years, BLS also has restricted data access to researchers. BLS is governed by the Confidential Information Protection and Statistical Efficiency Act (CIPSEA) and must report to the Office of Management and Budget on the implementation of CIPSEA.

2 See answer to question six under “Accessing our data,” Why are there noticeably fewer counts in CFOI data since reference year 2019? BLS.gov/iif/questions-and-answers.htm. 

3 See BLS.gov/iif/oshfaq1.htm#accessingourdata.

4 WhiteHouse.gov/briefing-room/presidential-actions/2021/01/20/executive-order-advancing-racial-equity-and-support-for-underserved-communities-through-the-federal-government/.

5 WhiteHouse.gov/briefing-room/presidential-actions/2023/02/16/executive-order-on-further-advancing-racial-equity-and-support-for-underserved-communities-through-the-federal-government/.

6 See 86 FR 28905.

7 See BLS.gov/rda/home.htm.

8 See BLS.gov/bls/cipsea-report.htm.

In 2021, 5,190 workers lost their lives on the job as a result of traumatic injuries, an increase from 2020, according to fatality data from the Bureau of Labor Statistics (BLS). The rate of fatal job injuries in 2021 was 3.6 per 100,000 workers, an increase from 2020 and a return to the fatality rate in 2016. Each day in this country, an average of 15 workers die because of job injuries—women and men who go to work, never to return home to their families and loved ones. This does not include workers who die from occupational diseases, estimated to be 120,000 each year. This number does not include those who died from being exposed to COVID-19 at work. Chronic occupational diseases receive less attention and place little accountability on employers because most are not detected until years after workers have been exposed to toxic chemicals and other agents, and because occupational illnesses often are misdiagnosed and poorly tracked. There is no national comprehensive surveillance system for occupational illnesses. In total, about 343 workers die each day due to job injuries and illnesses. 

In 2021, agriculture, forestry, and fishing and hunting continues to be the most dangerous industry (19.5 deaths per 100,000 workers), followed by transportation and warehousing (14.5 per 100,000 workers)—largely from the transportation industry, mining, quarrying, and oil and gas extraction (14.2 per 100,000 workers), construction (9.4 per 100,000 workers) and wholesale trade (5.1 per 100,000 workers).

Since 1992, the first year this report was issued, the job fatality rate in most significantly dangerous industries (manufacturing, construction, agriculture and mining) has decreased, except transportation and warehousing, which has increased 12%, from 13.0 per 100,000 workers in 1992. 

Transportation incidents, in particular roadway crashes, continue to be the leading cause of workplace deaths, responsible for 1,982 or 38% of all fatalities in 2021, followed by deaths from falls, slips and trips (850, or 16%) and exposure to harmful substances or environments (798, or 15%), including 464 unintentional overdoses. The increase in unintentional overdoses occurring in the workplace mirrors the unintentional overdose crisis seen outside of workplaces across the nation. In 2021, 106,699 individuals in the overall population died from an overdose due to illicit or prescription opioids, a 16% increase from the previous year. 

The job fatality rate for all self-employed workers—a group that lacks OSHA coverage—continues to remain high at 11.1 per 100,000 workers, more than three times the rate among wage and salary workers (3.1 per 100,000). In 2021, 906 contract workers died on the job—17% of all worker deaths. BLS had begun reporting details on fatalities that involve workers employed as contractors in 2012 in response to concerns about safety and health issues among these workers. Fatality data in 2019 and forward no longer report details of contractor deaths due to a 2020 BLS policy on disclosure methodology and reduction in publishable data—pulling back on transparency of details among contract worker deaths. 

States with the highest fatality rates include Wyoming (10.4 per 100,000 workers), North Dakota (9.0 per 100,000 workers), Montana (8.0 per 100,000 workers), Louisiana (7.7 per 100,000 workers), Alaska (6.2 per 100,000 workers) and New Mexico (6.2 per 100,000 workers). In 2021, the job fatality rate increased in more than half the states (26 states) since 2020.

9 U.S. Department of Labor, Bureau of Labor Statistics, Census of Fatal Occupational Injuries, 2021. 

10 Takala, J., P. Hämäläinen, N. Nenonen, et al. “Comparative Analysis of the Burden of Injury and Illness at Work in Selected Countries and Regions,” Central European Journal of Occupational and Environmental Hygiene 23:1–2, 6–31, (2017). Available at icohweb.org/site/images/news/pdf/CEJOEM%20Comparative%20analysis%20published%2023_1-2_Article_01.pdf

11 National Institutes of Health. National Institute on Drug Abuse. Drug Overdose Death Rates. Feb. 9, 2023. Available at NIDA.NIH.gov/research-topics/trends-statistics/overdose-death-rates#:~:text=More%20than%20106%2C000%20persons%20in,drugs%20from%201999%20to%202021.