OBJECTIVES To describe a comprehensive health protection program for rotating shift employees and evaluate the program effectiveness in injury and illness prevention. METHODS For 14,128 shift and 17,218 day wage employees, occupational medical records were linked to job assignment records and studied over an 11-year period. RESULTS Between 1995 and 2005, initiatives directed to shift employees contributed to their 59% and 100% greater participation in medical examinations and health seminar days, respectively, compared to day wage employees. Injury rates declined over time and with increasing employee age and were not elevated among rotating shift compared to day wage employees. Clinic visit rates for acute illnesses were generally higher for day than shift work employees. CONCLUSION Coupling of active medical monitoring with additional health and safety initiatives appears to mitigate the expected adverse physiological and psychosocial stresses of shift work.