The recommendations in Ryan's report show that the state needs to make systemic changes, Mead said after releasing the report Tuesday.

"I believe that we must find ways to get workers in Wyoming home safely at the end of the day," he said in a statement.

Ryan wasn't available to elaborate on his findings. He resigned the day after turning in his report last month. A phone message left for him through the Cheyenne company that has hired him, HCMS Group, wasn't immediately returned Wednesday.

In his report, Ryan recommended expanding the role of the state Occupational Health and Safety Commission to better coordinate the state's "disjointed" workplace safety efforts.

He called for better workplace safety data. Wyoming lacks a centralized database of workplace injuries and deaths, and there is a two-year lag in occupational safety data from the U.S. Department of Labor, he pointed out.

The state workplace safety office should respond faster when employers voluntarily request safety inspections, he wrote. He characterized voluntary inspections as a better route to improved workplace safety than non-voluntary enforcement inspections.

Ryan also recommended that Wyoming support industry efforts to develop, monitor and enforce safety standards and practices.

Wyoming's petroleum industry has been aware of Ryan's work and takes his efforts to heart, said Don Burkhart, chairman of the Petroleum Association of Wyoming's safety committee and health and safety adviser for BP in Wyoming.

The report makes good and interesting points although some are generalities that don't apply to every employer in the petroleum industry, Burkhart said.

"There are a number of companies in Wyoming that have a very sound, strong culture of safety," he said. "Many of those companies have the safety record to show that culture exists."

Gov. Dave Freudenthal hired Ryan in 2010 to examine Wyoming's workplace fatality problem. Ryan said in his report he spent a year analyzing 17 years of workplace fatality data and reading workplace fatality reports. Eighty-five percent of those reports, he wrote, show safety procedures not being followed.

Ryan also reported that he spoke to hundreds of employees at various-sized companies in Wyoming's major industries. They told him the safety training they got often was not enforced at the worksite, he wrote.

Workers described a breakdown in communication between management and employees regarding safety. Employers tell workers to "get the job" done while not enforcing safety, he wrote.

Mead said he has decided to move the vacant occupational epidemiologist to the state workplace safety office, which he said should help overcome regulatory barriers to accessing data on workplace accidents. An epidemiologist deals with the study of disease in a population.

"Over the last year, we learned that access to timely data is a barrier to adequate analysis and this must be addressed," he said.

The workplace safety office recently developed safety rules for oil and gas drilling, and the state Occupational Safety and Health Commission approved most of them last month. Among other changes, the new rules prohibit smoking within 75 feet of a well bore and require rig workers to get annual fire extinguisher training.

Other proposed rules that apply to flame-retardant clothing, exposure to hydrogen sulfide and anchoring for small drilling rigs were tabled for additional work.