On December 14, 2007, NIOSH received a joint union/management request for an HHE at Tru-Weld Grating Inc. in Litchfield, Illinois. The International Brotherhood of Boilermakers, Local 486 and management at Tru-Weld Grating submitted the request to investigate the high number of MSDs in employees working in the barline, welding, and saw areas. On February 19-20, 2008, NIOSH investigators conducted an evaluation. The NIOSH ergonomist observed and videotaped job tasks in the work areas. The NIOSH epidemiologist conducted confidential health interviews with employees at the plant, reviewed OSHA's Form 300 Log of Work-Related Injuries and Illnesses (OSHA Logs), analyzed incidence rates from the OSHA Logs for the past 5 years, and reviewed employees' compensation data for the past 4 years. NIOSH investigators observed that most employees are exposed to risk factors for developing WMSDs due to awkward postures, forceful exertions, and repetitive motions. These included prying materials loose with pry bars, squatting and bending over at the waist and back to maneuver heavy materials, reaching at or above shoulder height, and manipulating material using awkward shoulder and wrist postures. The OSHA Logs and employees' compensation data review indicated that most WMSDs during the past 5 years (2003-2007) involved the back and shoulder, resulting in 698 days away from work and 49 days on job transfer or job restriction. The most common job involving WMSDs on the OSHA Logs and employees' compensation reports was Machine Operator (11), and the most common work location was on the #2 and #3 welders (7). We calculated the following injury/illness incidence rates from the OSHA Logs at the Tru-Weld Grating plant: 13.0 in 2003, 19.5 in 2004, 15.8 in 2005, 36.0 in 2006, and 24.3 in 2007 per 100 full-time employees. Incidence rates of nonfatal injury and illness were higher at the Tru-Weld Grating plant than incidence rates for ornamental and architectural metal work manufacturing facilities nationally from 2003-2007. Of the 26 employees interviewed, 12 employees (60%) from the barline, welding, and saw areas reported 20 upper and lower extremity musculoskeletal symptoms that were worse at work. The most common areas where musculoskeletal symptoms were reported were the shoulder (5) and back (5). Employees also reported working mandatory overtime, missing work, seeing a healthcare provider, and transferring to different departments because of MSDs.