The safety and health hazards associated with the horse-racing industry, along with a lack of adequate disability and health insurance for its workers, prompted an investigation by Congress which culminated with hearings in 2005. One of the outcomes from these Congressional hearings was a letter from the Chairman and Ranking member of the Subcommittee on Oversight and Investigations of the U.S. House of Representatives Committee on Energy and Commerce to the Department of Health and Human Services Secretary, requesting assistance from the National Institute for Occupational Safety and Health (NIOSH) in investigating the safety and health hazards in the horse-racing industry. In response to this request, NIOSH conducted a review of the available safety and health literature on thoroughbred and standard bred horse racing; conducted site visits to two racetracks in Lexington, Kentucky, Keeneland Race Course and the North American Racing Academy; completed a fatality investigation; conducted analyses of injury data from relevant data sources; reviewed regulations governing the horse-racing industry in the United States and other countries; and held a public meeting in order to garner concerns about the health and safety of workers in the horse-racing industry. This document is intended for all workers associated with the horse-racing industry, including jockeys, other race track workers, horse and race track owners, and racing commissions. The document summarizes NIOSH's efforts in responding to the Congressional inquiry and provides recommendations for reducing the number of injuries and adverse health effects for workers in the horse-racing industry.