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Background This paper examines serious and fatal pneumatic nail gun (PNG) injury investigations for workplace, tool design, and human factors relevant to causation and resulting OS&H authorities’ responses in terms of citations and penalties. Methods The U.S. OSHA database of Fatality and Catastrophe Investigation Summaries (F&CIS) were reviewed (1985 - 2012) to identify n=258 PNG accidents. Results 79.8% of investigations, and 100% of fatalities, occurred in the Construction industry. Between 53-71% of injuries appear preventable had a safer sequential trigger tool been used. Citations and monetary penalties were related to injury severity, body part injured, disabling of safety devices, and insufficient personal protective equipment (PPE). Conclusions Differences may exist between Construction and other industries in investigators interpretations of PNG injury causation and resulting citations/penalties. Violations of PPE standards were penalized most severely, yet the preventive effect of PPE would likely have been less than that of a safer sequential trigger.