This study examined the role of management practices and legislation on OSH (occupational safety and health) implementation in SMEs (small and medium enterprises) in Malaysia. A questionnaire was administered to 152 SMEs across various industries in Northern Malaysia. The results of a hierarchical regression analysis showed that employee participation and safety training were important for achieving certain OSH implementations. Additionally, legislation enhanced the relationship between safety rewards and OSH implementations, and higher levels of legislation strengthened the impact of management commitment and safety training on OSH implementation. The study provides insights into improving OSH practices in Malaysian SMEs through strategic management practices and appropriate legislative support.