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During July/August 2005, Palau hosted the VII South Pacific Mini Games. With an expected influx of at least 2000 athletes and visitors, the Palau Ministry of Health (MOH) decided to operate under an Emergency Incident Command Structure for the duration of the event. Surveillance for infectious diseases and injury was carried out under this framework by the Epidemiology/Intelligence team (Epi Team) established for the event. Health providers traveling with visiting teams or working in Koror were requested to complete daily log sheets of encounters using standardized case definitions. These sheets were collected each evening, either from designated “drop-off” points or directly from the team accommodation, and entered into a Microsoft Access database. Reports were generated and reviewed each morning to provide current statistics for the Incident Command meeting and determine further actions as appropriate. 912 games related encounters were recorded. 19.5% (178) of these presentations were at MOH operated facilities or field teams. The remaining 80.5% presented to visiting medical delegations. 689 (75.5%) of the presentations were considered to be “initial” visits, with the remainder recorded as follow-up visits. Of these “initial” visits the most common diagnoses were injury, prevention (massage or strapping), upper respiratory illness, headache, and dehydration. There were no outbreaks of infectious disease detected during the games. Although several issues with the surveillance methodology arose during the games, the event highlighted the importance of good communication and a flexible team approach in carrying out effective surveillance. It is recommended that future events adopt a similar approach, with a strong emphasis given in the planning stages to establishing direct contact between the staff responsible for surveillance and field and visiting health personnel. (PHD, 2005 Vol 12 No 2 Pages 9 -16)