Fall-related occupational injuries and fatalities are still serious problems in the U.S. construction industry. Two Bureau of Labor Statistics databases — Census of Fatal Occupational Injuries and Survey of Occupational Injuries and Illnesses — were examined for 1992–2000. An important subset of falls-to-lower-level incidents is when workers fall through openings or surfaces, including skylights. A total of 605 fall-through fatalities occurred during 1992–2000. Also, 21,985 workers were injured seriously enough from fall-through incidents to miss a day away from work (DAFW). Fall-through injuries are among the most severe cases for median number of DAFW. Median DAFW were 35, 11, 25, 12, and 36 for fall-through roof and floor openings, roof and floor surfaces, and skylights, respectively, compared to 10 DAFW for all fall-to-lower-level incidents in all U.S. private industry. A conservative approach, which assumes that direct and indirect costs are equal, estimates a range of $55,000–$76,000 for the total cost of a 1998 DAFW fall-through injury. Current work practices should use commercial fall-prevention products to reduce the frequency and costs of fall-through incidents. These analyses have identified a subset of fall-related incidents that contribute to excessive costs to the U.S. construction industry. Researchers can use a systems approach on these incidents to identify contributing risk factors. Employers and practitioners can alert managers and work crews about these dangerous locations to eliminate these hazards that are often obvious and easy to rectify.