The industrial accident rate in Hong Kong has steadily declined over the past 20 years, but has plateaued over the past 5 years and worryingly the fatality rate has been flat for over 15 years. This clearly highlights a level of under reporting of accidents in that normally accidents and fatalities are in a roughly constant proportion to one another. This is corroborated by informal discussions with the insurance industry. Using an institutional analysis approach to the study, the research team has drawn the conclusion that institutional, contractual and policy factors adversely affect Hong Kong’s OHSW statistics. This paper highlights the fact that many of these factors are not under Hong Kong contractor’s control. However, there is always opportunity to improve performance and a series of potential initiatives are proposed that target industry-wide issues. An overarching issue for a company is the balance between the systems it operates and the culture within which it operates. A key issue in project-based organisations is to operate with rigid flexibility throughout the business. The goal is rigid conformance to safety standards but flexibility in how these standards are achieved. This characteristic is typical of high reliability organisations.