During 2003-2010, the U.S. oil and gas extraction industry (onshore and offshore, combined) had a collective fatality rate seven times higher than for all U.S. workers (27.1 versus 3.8 deaths per 100,000 workers). The 11 lives lost in the 2010 Deepwater Horizon explosion provide a reminder of the hazards involved in offshore drilling. To identify risk factors to offshore oil and gas extraction workers, CDC analyzed data from the Bureau of Labor Statistics (BLS) Census of Fatal Occupational Injuries (CFOI), a comprehensive database of fatal work injuries, for the period 2003-2010. This report describes the results of that analysis, which found that 128 fatalities in activities related to offshore oil and gas operations occurred during this period. Transportation events were the leading cause (65 [51%]); the majority of these involved aircraft (49 [75%]). Nearly one fourth (31 [24%]) of the fatalities occurred among workers whose occupations were classified as "transportation and material moving." To reduce fatalities in offshore oil and gas operations, employers should ensure that the most stringent applicable transportation safety guidelines are followed.