The two objectives of this article are: a) to describe the German School Injury Surveillance System and b) to determine major trends and patterns of different school-associated injury indicators. The database covers all children and adolescents from nursery school through university during their time at school and day care, including their way to and from school. Presently, this results in 17.5 million insured young persons, or 21.2% of the German general population. The surveillance system includes two main informational sources: school accident and medical accident reports.In 2003 over 1.5 million school-related injuries received medical attention in Germany. This is an incidence rate of about 86 injuries per 1000 students. Between 1975 and 2003, the mortality rate declined from 23.4 to 7.7 per million. This is a drop of 67% in about 30 years.