The nation needs a robust occupational health and safety (OSH) surveillance system to provide critical information for informing policy development, guiding educational and regulatory activities, developing safer technologies, and enabling research and prevention strategies that serves and protects all workers. This report provides a comprehensive assessment of the state of surveillance. The recommendations address the strengths and weaknesses of the envisioned system relative to the status quo and both short- and long-term actions and strategies needed to bring about a progressive evolution of the current system.