Approximately 2700 manual handling injuries recorded among disability services workers in an Australian state government agency between 1997 and 2000 were analysed to identify high-risk groups and leading causes to be targeted for prevention. Client support, including assisting clients into and out of bed and holding clients during epileptic seizures, had the highest cause-specific injury rate per 100 full-time equivalents (12.2, 95% confidence interval (CI) 6.2–20.2). Women had significantly higher rates than men, an average of 29.8 (95% CI 19.9–41.7) compared with 16.6 (95% CI 9.5–25.7). Gender (being female) and low job classification significantly increased the odds of an injury resulting in time off work. Only gender significantly predicted the likelihood of high compensation payments. Together with the surveillance data, responses to the questionnaire survey of 120 workers indicate a need for effective ergonomics intervention.