Head injuries are the reason for which workers' compensation claims are most frequently filed and have the highest average cost per claim. The purpose of this study was to identify the construction industry trades with the greatest risk for an occupational fatality due to impact-related head injuries. Proportionate mortality ratios identified the highway and streets construction trades as having over three times the expected number of fatalities (P < 0.01) due to impact-related head injuries than expected, while the heavy construction trades had over two times the expected number of fatalities (P < 0.01) due to impact-related head injuries. The majority of these fatalities were the result of vehicle incidents and the worker's being struck by various forms of equipment that were in the process of being moved. Prevention strategies should be focused on vehicle safety, driver education, safe material handling, and the use of hard hats.