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Little empirical data exist to identify the reasons for underreporting in the US Bureau of Labor Statistics (BLS) non-fatal occupational injury and illness data.We interviewed occupational injury and illness record keepers from Washington State establishments that participated in the 2008 BLS Survey of Occupational Injuries and Illnesses (SOII). Qualitative and quantitative methods were used to explore recordkeeping and business practices that may explain SOII's incomplete case capture compared with WC claims data.Most participants (90%) did not comply with OSHA recordkeeping regulations. Other factors including using workplace injury data to evaluate supervisors' or SOII respondent's job performance, recording injuries for a worksite that operates multiple shifts, and failing to follow SOII instructions were more common among establishments with unreported WC claims.Business practices that incentivize low injury rates, disorganized recordkeeping, and limited communication between BLS and survey respondents are barriers to accurate employer reports of work-related injuries and illnesses. Am. J. Ind. Med. 57:1133–1143, 2014. © 2014 The Authors. American Journal of Industrial Medicine published by Wiley Periodicals, Inc.