The occupational injury experience of the U.S. and Australian construction industries for 1988-1991 was compared to identify similarities and differences in risk and to share information vital for planning strategies for prevention. There were 4,158 deaths in the U.S. and 264 in the Australian construction industries. Workers in both countries, particularly laborers, were at high risk, with mean annual rates of 13.8/100,000 and 11.6, respectively, more than double the national averages. Falls, motor vehicles, electrocutions, and machinery were the leading causes of death in both countries, and accounted for 69% of the fatalities in the U.S. and 71% in Australia. International collaborations focusing injury and fatality prevention efforts on the common leading causes and high risk groups, and sharing successful prevention experiences between countries could save the lives of many construction workers world wide.