In order to improve safety performance, Malaysian government has gazetted an occupational safety and health policies to provide guidelines to be followed in dealing with occupational safety and health activities at site. Meanwhile, Factories and Machinery Act provide regulation with respect to the health, health and welfare of person, machinery and for matters connected therewith for the control of factories. This paper aims to identify cause of accidents and the provisions of safety regulations in construction projects in Malaysia. Methodology is by analysing the DOSH report. Statistic from DOSH shown that from 2015 to 2019, about 116 increase in accident cases. The main causes of accidents are work at high, unsafe work practice or conditions and failure of structure. Under Section 15 of OSHA 1994, contractors and employers can be charged under this section if fail to provide a healthy and safe working environment for their employees. © The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2021.