In 2008, among U.S. workers, 5,071 died from occupational injuries, 3.7 million suffered serious injuries, and 187,400 became ill from work-related exposures. The estimated annual direct and indirect costs of occupational injury, disease, and death range from $128 billion to $155 billion. While the underlying causes vary, a recent study implicates design in 37% of job-related fatalities. Thus, to protect lives and livelihoods, stakeholders across all industrial sectors of the economy need a comprehensive approach for addressing worker health and safety issues by eliminating hazards and minimizing risks to workers throughout the life cycle of work premises, tools, equipment, machinery, substances, and work processes, including their construction, manufacture, use, maintenance, and ultimate disposal or re-use. The following document provides the rationale, mission, objectives, outcomes, and timeframe for the Prevention through Design (PtD) National Initiative. The mission of the PtD National Initiative is to prevent or reduce occupationally related injuries, illnesses, fatalities, and exposures by including prevention considerations in all designs that affect individuals in the occupational environment. This will be accomplished through the application of hazard elimination and risk minimization methods in the design of work facilities, processes, equipment, tools, work methods, and work organization. Although the ultimate goal is to "design out" potential hazards at the beginning phases of a project, rather than dealing with problems inherent in completed systems, PtD methods also can effectively be applied to existing processes and equipment. Eliminating hazards and minimizing risks during the design, redesign, and retrofit of facilities, work processes, and equipment may ultimately save money and, more critically, will protect workers. PtD is a national initiative; the nation must focus its collective attention on eliminating hazards and minimizing risks to workers and the work environment, because no single organization or occupational discipline can achieve its goals. Success will come through a coordinated, phased approach to PtD activities that takes into consideration the unique challenges faced by businesses within all industrial sectors. Through the collaborative efforts of industry, labor, professional organizations, academia, government agencies and PtD experts, and with the commitment of professions affected by PtD issues (including architects, industrial designers, and engineers; purchasing, finance, and human resource professionals; and health and safety experts), the PtD National Initiative can save lives and demonstrate financial value.