Purpose. Whilst occupational safety and health (OSH) management is recognized as an important mechanism for addressing poor OSH performance, limited empirical insight is available on OSH management by construction companies in sub-Saharan Africa. This study investigated OSH management by construction companies (i.e., contractors) in Malawi in order to unpick implementation issues that need attention. Materials and methods. 46 OSH management practices were probed through a survey of contractors. Results. Implementation of OSH practices amongst contractors is low, particularly for practices related to the policy, organizing, measuring and reviewing, and auditing elements of OSH management. Company size is associated with implementation of nearly half of the 46 OSH practices. Certification of the company to Standard No. OHSAS 1800:2007 is associated with the implementation of fewer practices. Conclusions. OSH management improvement efforts would need to focus on the elements with particularly low implementation of practices as well as include initiatives that focus on helping microenterprises to improve their OSH management. The association between business characteristics and OSH management may be more evident with certain elements, such as the organizing element. Furthermore, certification to Standard No. OHSAS 1800:2007 may not necessarily translate into greater implementation of OSH management practices, especially in developing countries.