Lean practice is recognised for having a great potential in promoting safety risk management in off-site construction (OSC). This paper presents results of a study conducted to assess the impact of lean practice on safety risk management in OSC in a developing country. A quantitative approach using a survey-based questionnaire was adopted. Lean management practices (LMPs) identified from a literature review were empirically tested using a sample survey of 103 OSC contractors. The survey responses were subjected to descriptive and inferential statistics. The top ranked LMPs for safety risk management in OSC included two mistake-proofing practices, i.e., use of personal protective equipment (PPE) and use of hazard warning equipment; two last planner system (LPS) practices, i.e., involvement of workers in safety planning and providing necessary working equipment; and one first run studies (FRS) practice, i.e., critical analysis of work methods. These LMPs are useful in controlling high-consequence safety risks in OSC. Based on evidence found in this study, the paper argues that lean practice can bring great value to safety risk management in OSC in countries where OSC is transitioning.