The United States currently depends on approximately 1.1 million fire fighters to protect its citizens and property from losses caused by fire. Each year in the United States, approximately 100 fire fighters die in the line of duty. Sudden cardiac death is the leading cause of fatalities, followed by trauma. In 1998, Congress appropriated funds to the National Institute for Occupational Safety and Health (NIOSH) for a fire fighter safety initiative. As part of this initiative, NIOSH developed and implemented the Fire Fighter Fatality Investigation and Prevention Program (FFFIPP). The overall goal of the NIOSH FFFIPP is to reduce the number of fire fighter fatalities. To accomplish this goal, NIOSH conducts investigations of line-of-duty fire fighter deaths to identify contributing factors and to generate recommendations for prevention. This document summarizes the most frequent recommendations from the first 8 years of the NIOSH Fire Fighter Fatality Investigation and Prevention Program (FFFIPP). The overall goal of the program is to reduce the number of fire fighter fatalities. Through 2005, the FFFIPP investigated 335 fatal incidents involving 372 fire fighter fatalities. The investigations encompassed a variety of circumstances such as cardiovascular-related deaths, motor vehicle accidents, structure fires, diving incidents, and electrocutions. Fatalities have been investigated in career, volunteer, and combination departments in both urban and rural settings throughout the United States. This document shares the most common recommendations from the 335 investigations and more than 1,286 recommendations that were developed by NIOSH investigators. These recommendations were developed using existing fire service standards, guidelines, standard operating procedures, and other relevant resources over the first eight years of the program. Fire departments can use this document when developing, updating, and implementing policies, programs, and training for fire fighter injury prevention efforts.