Objective: To identify the causes of current low reporting levels for occupational diseases in Spain, and attain a consensus regarding recommendations for improvement. Methods: Opinions were solicited, through two rounds using the Delphi technique, from a convenience sample of professionals, followed by a national workshop to analyze study results and reach consensus on conclusions. Results: All workshop participants (n=60) agreed on twelve causes and recommendations for improvement related to worker awareness, training of physicians, the role of providers in the reporting system, competing work demands, diffi culties in accessing databases, definition of occupational disease, lack of coordination among agencies, conflicts of inter est, and concerns that increased reporting could lead to more workplace inspections or singling out of specific autonomous communities. Conclusions: Physicians involved in reporting of occupational diseases, regardless of practice setting, easily identified reasons for low reporting and reached consensus on the best ways for solving and prioritizing current limitations in the Spanish reporting system.