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Work injuries represent a relevant public health issue. Evaluation of associated factors is an important tool for occupational health surveillance. We aimed to identify factors associated with the severity of work injuries in Piracicaba from 2004–2013. This is a cross-sectional study and is part of ”Work Accident: from socio-technical analysis towards the social construction of changes” supported by the São Paulo Research Foundation. Work injuries data were retrieved from the Work Accident Surveillance System (SIVAT) for formal workers with at least 18 years old for the period 2004–2013. Using a multiple logistic regression model, odds ratios (OR) and their 95% confidence intervals (CI95%) were calculated considering the severity of the injury (severe or fatal versus moderate and light) and selected variables (injury type, sex, age group). All analyses were done using STATA 13.1. In the period 2004–2013, 78 198 work injuries occurred with formal workers in Piracicaba, being 1522 (1.92%) severe or fatal accident. In severe or fatal accident, the frequency was higher among workers from manufacturing industry (750;49%), followed by services (389;26%). Increased risk for severe and fatal injuries was found for men (OR=1.16 CI95%:1.01–1.33), route accident (OR=2.0;CI95%:1.77–2.26), and an upward trend in risk with increasing age (trend test:p<0.001). Action plans to prevent workplace injuries and deaths should be designed considering that men at older ages working in manufacturing industry and in the service sectors are at increased risk. SIVAT represents an important tool to assess worker’s health in the Piracicaba region and guide occupational health surveillance.