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Underreporting of occupational injury and illness has been an important issue in Taiwan. We tried to implement an integrated surveillance system in the emergency services of National Cheng Kung University Hospital to screen work-related accidents. The system mobilised staffs of triage, registration and doctors to report occupational causes. A total of 4097 events were identified from Feb 2015 to Feb 2017, among which 2722 were work-related, and 1375 commuting injuries. Work-related events were predominant males (71.7%), but equally in commuting injuries. 1532 events were sent by ambulance, 498 cases hospitalised in the first month, and 4 patients died within 30 days after emergency services and all fatal cases were work-related injuries. The majority of diagnoses were contusions, abrasions and lacerations, totally accounting for 43.1%. However, significant proportion of head injuries (n=751, 18.3%), fractures (n=351, 8.6%), burns (n=264, 6.4%) including 62 cases (1.5%) of chemical burns, and 106 cases (4.4%) of amputations were found. The results were different from the government funded reporting system where most frequently reported were chronic musculoskeletal diseases. The total medical costs were about 2.9 million USD, based on a conservative estimation accounting 90 days from the first encounter. This study revealed the fact of underestimation of occupational injuries and illness resulting in significant health and societal impacts. The emergency room based surveillance system can augment the conventional reporting system. Furthermore, cluster analysis and work associated disability should be investigated to improve occupational safety and labour right.