We assessed risk factors for fall-related farm injuries in a population-based, case-control study. Cases had to reside in a defined geographic region served by a single medical center. Multiple sources reported cases, and a special farm census enabled random selection of controls. The annual risk of farm fall injury was 7.5 (95% CI: 5.7, 10.0) per 1,000 person-years. The crude incidence rate was higher in men, while the rate based on hours of farmwork was higher in women. In a multivariate analysis of risk factors, three factors were significantly associated with the risk. The risk of fall injury increased 2% (95% CI: 1%, 4%) per hour worked. Residents of farms with some farm workers not living on the farm had a fall injury rate 2.5 (95% CI: 1.0, 6.2) times greater than residents of other farms. Residents of farms with registered cows had one-third (95% CI: 0.14, 0.93) the risk of residents of other farms. To identify environmental hazards for fall injuries, researchers from several disciplines may need to collaborate in the design and conduct of studies that include injury site investigations. © 1996 Wiley-Liss, Inc.