Data were compiled and analyzed on the estimated frequency and characteristics of deaths related to on-farm manure storage and handling facilities for the period of 1975 through 2004. Sources included published government reports, national and local media, on-line searches, published farm fatality reports, and prior litigation. No prior research was identified that addressed the magnitude of the problem, nor documented evidence-based intervention strategies. Data from 77 fatalities along with 21 severe injuries and 14 international fatality cases were identified, documented and coded for analysis. Analysis of the 77 fatalities showed that victim characteristics and causative factors did not reflect previously reported patterns; i.e., over half of the fatalities involved dairy operations and 21% involved persons under the age of 16. The largest percentage (34%) of deaths occurred to persons conducting repair or maintenance activities on manure handling equipment, while the second largest group (22%) were attempting to perform a rescue of another person. The most frequently identified cause of death was asphyxiation with elevated levels of sulfide levels in the blood noted in some cases. The peak period of incidents were during the hottest part of the summer and often associated with transferring of manure for application to crop ground. Recommendations included the need to revise ASABE EP470 Manure Storage Safety Practice to include engineering controls that would reduce the need for farmers and farm workers to enter spaces containing toxic manure-related gases. In addition, the need to educate owner/operators and employees concerning the hazards associated with agricultural manure storage structures and equipment, especially those classified as permit-required confined spaces, should be considered, including the need for appropriate warnings and entry procedures. Incorporation of current OSHA confined space entry procedures into these facilities is also recommended.