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This survey was conducted to provide national incidence rates and risk factors for exposure to blood among paramedics. The present analysis assesses reporting of exposures to employers.A questionnaire was mailed in 2002—2003 to a national sample of paramedics selected using a two-stage design. Information on exposure reporting was obtained on the two most recent exposures for each of five routes of exposure.Forty-nine percent of all exposures to blood and 72% of needlesticks were reported to employers. The main reason for under-reporting was not considering the exposure a "significant risk." Females reported significantly more total exposures than males. Reporting of needlesticks was significantly less common among respondents who believed most needlesticks were due to circumstances under the worker's control. Reporting was non-significantly more common among workers who believed reporting exposures helps management prevent future exposures. Reporting may have been positively associated with workplace safety culture.This survey indicates there is need to improve the reporting of blood exposures by paramedics to their employers, and more work is needed to understand the reasons for under-reporting. Gender, safety culture, perception of risk, and other personal attitudes may all affect reporting behavior.