The construction industry plays a significant role in the economy of developing countries. The sector is, however, also one of the most hazardous with frequent accidents and health-related problems. The health and safety practices of construction small and medium-sized enterprises (SMEs) in Ghana are examined with a view to improving the health and safety performance of the sector. A survey questionnaire was administered to owner/managers of SMEs, with a response rate of 32% of the sampling frame. Few of the SMEs adopted proactive health and safety practices. However, health and safety practices identified as being particularly associated with firm characteristics were: accident investigation procedures; accident reporting procedures; use of health and safety posters; documentation of method statements; and health and safety inductions. The diversity of health and safety practices associated with different size categories of SMEs and constraints to improving health and safety are highlighted. A positive change is needed in the attitudes of owner/managers which takes into account size-related constraints in order to improve the health and safety performance of Ghanaian SMEs.
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