The construction sector in the Sultanate of Oman is one of the most important tributaries to the economy of the country. Attention to all its aspects guarantees financial sustainability, and make of it an attractive environment for work and stimulating investment. Among the most important of these elements is the relationship between financial return and commitment to Occupational Health and Safety (OHS) laws. The government of the Sultanate of Oman opts towards to the enhancement and development of the small and medium companies, which adopted many concessions and facilities that guarantee the safety and growth of this sector to be an active contributor to build the economy of the Sultanate. However, the level of compliance to the Occupational Health and Safety by the small and medium construction companies is limited due to many factors such as a limited budget, the lack of understanding of the importance of maintaining safety climate within the company, and the diversity of the culture of the construction workers. Hence, improving such factors will contribute to lowering the construction-related accidents. This research focuses on the identification of challenges that limits the small and medium construction companies' performance in adopting the best practices in the Occupational Safety and Health. Small and medium construction working in the water sector in Oman is the context of this study. This research investigates the adaptation and the understanding of eleven OHS dimensions by small and medium construction companies. These are (1) individual commitment to OHS, (2) management's commitment to OHS, (3) effectiveness of individual communication, (4) management safety priority, (5) management ensuring safety justice, (6) management safety empowerment, (7) learning from incidents, (8) safety climate, (9) Health, Safety, and Environment (HSE) learning conditions, (10) safety resilience/ recovery after incidents, and (11) HSE preventive interaction. Those dimensions are also substantial contributors toward the Zero Accident Vision, and recommend solutions to bridge the gaps in implementing them which will pave the way toward a Zero Accident Vision in Oman. Therefore, the second objective of this research is defined The research was conducted in two parts using questionnaire surveys and interviews. The questionnaire survey method was performed to identify the dimensions, which challenge the small and medium construction companies to improve in the OHS domain. A questionnaire survey used in this research was adopted from the Partnership for European Research in Occupational Safety and Health (PEROSH). The purpose of the questionnaire is to investigate the factors that contribute V to success in enhancing safety and avoiding accidents in construction companies. The questionnaire survey was translated into four languages (English, Arabic, Urdu, and Hindi), and covers eleven dimensions, and consist of 73 attributes (questions). The questionnaire was distributed among small and medium construction companies working in the water sector. EightyEight responses were received and analyzed. The findings show that the mean results of ten dimensions ranged between 2.43 and 2.96 out of 5 (Likert scale). Which means improvement is required. This result was used to formulate the interview questions for the second part of the research. The interview questions focused on the Management's commitment to OHS, effectiveness of individual communication, management safety priority, justice and empowerment, how organizations learn from incidents with boosting the learning platform, safety climate, correctives and corrections plan after accidents. Two rounds of 14 interviews with a saturation level of 85.7 % were conducted with experienced personnel working in public and private sectors. The interviews results were analyzed and the recommendations for improvement toward effective implementations of the 10 OHS dimensions were reported.