The paper begins with a discussion of recent developments in systematic Occupational Health and Safety Management (OHSM) with reference to OHSM as a regulatory strategy, the systems developed by some larger corporations, proprietary OHSM products, as well as initiatives in standardisation and certification of OHSM systems. The core elements of systematic OHSM are introduced in Section 4, and the concept of a system is discussed. The paper then looks more critically at some of the preconditions for successful implementation of the core elements of OHSM in Section 5, as well as some internal organisational factors and external influences that shape OHS performance but are not generally addressed in OHSM standards, guidelines and products (Section 6). The challenges to OHSM presented by the increasing trend to precarious employment and the growth in small business are canvassed in Section 7. Research evidence on the effectiveness of the OHSM strategy is reviewed in Section 8 before returning to a discussion of whether, and if so how, OHSM might be pursued in OHS regulation in Section 9.