Employee representation is central to any workplace health policy. But in most European countries, large numbers of workers have no such representation. Structured worker representation is the precondition for workers to play into health and safety. Many surveys have shown that a direct connection exists between a company having a workers' representation body and the quality of workplace prevention policy. Just having such a representation body is not necessarily enough to ensure effective participation, but experience shows that where such representation is lacking, the forms of direct participation sometimes propounded by employers are just a smokescreen. In all but a very few cases, there is a general lack of knowledge and debate about the factors and conditions by which workers' reps can exercise a key role in a preventive strategy. For the trade union movement, the coverage of all the workers by forms of health and safety representation is a major objective for the coming years.