Public health surveillance – the continuous and systematic collection and analysis of health-related data – is essential to understand and prevent injuries before they occur. However, previous data reports released by the U.S. Coast Guard have revealed that non-fatal injuries among recreational boat occupants have often gone underreported, limiting the ability of officials to track and prevent these injuries. To address this need, the Safe States Alliance and the National Association of State Boating Law Administrators (NASBLA) partnered with the United States Coast Guard to convene the Recreational Boat Occupant Injury Surveillance Roundtable: a group of recreational boating and public health injury prevention experts who were brought together to identify surveillance gaps, determine needed improvements, and develop a set of recommendations to improve boat occupant injury surveillance. The roundtable was the first tier of activities in a three-tier project. The recommendations developed served as a guidepost for the work of an injury and surveillance workgroup (ISW) convened in tier two of the project.