Although the risks of certain chemical agents in the hospital environment are well known, problems associated with the entire spectrum of chemicals are not. To address this issue, we analyzed incident reports generated in response to chemical exposures in an academic medical center. We also reviewed workers' compensation clinic logs and the OSHA 200 log to obtain information on medical follow-up and severity. A total of 253 exposures occurred during the 3 years from 1988 to 1990. The overall incidence rate was 8.0 per 1000 person-years. Exposure rates by job title were highest for housekeepers (60.1 per 1000 person-years), followed by maintenance workers (18.6), and laboratory technicians (13.1). The most frequently involved chemical groups were disinfectants (25.9%), solvents (16.8%), and cleaning compounds (12.1%). Exposure by the dermal route was most common (37.9%). Thirteen percent of the exposures resulted in lost time and a similar percentage was reported on the OSHA log. Medical treatment was obtained by 53%. Implications for hazard communication, recordkeeping, and prevention are discussed.