AbstractBackgroundOver the last decade, there has been a decline in injuries with days away from work in construction, associated with an increase in injuries with restricted work activity only.MethodsWe abstracted demographics, diagnosis, cause‐of‐injury, and hospital discharge information for 481 workers from one large construction project treated in an urban Emergency Department (ED). The project safety team provided data on all injuries from this site, including first aid cases.ResultsThis site had fewer injuries with days away from work than expected from national rates. Two hundred and fifty‐six injuries were reported on the OSHA log, and of those 93 entailed days away from work; 1,515 injuries were considered first aid/medical only. We used a sample of the data to estimate that the site classified as “recordable” 128 of the 481 ED‐treated injuries from this site (27%).ConclusionsThe pattern of injury varies depending on the subset of injuries examined. Lost time injuries, as reported in BLS data, record fewer lacerations and eye injuries, and more strains and sprains. No one surveillance system presents the full spectrum of occupational injury. Tracking all injuries allow early recognition of injury risks, and therefore can lead to more effective prevention. Am. J. Ind. Med. 44:191–196, 2003. © 2003 Wiley‐Liss, Inc.