Work-related falls from roofs remain a significant problem for workers in the construction industry. Knowledge about the main causative or initiating factors leading to fall incidents is desperately needed for fall prevention intervention. From biomechanical and psychophysiological perspectives the majority of occupational falls, including falls from roofs, can be regarded as loss-of-balance incidents. The primary objective of this paper is to summarize the current knowledge from multiple fields about factors that are related to the control of balance during roofing work. An extensive literature review identified a number of environmental, task-related and personal factors that degrade the control of balance and could be associated with the initiation of falls from roofs. These factors include visual exposure to elevation; unstable visual cues and inadequate visual information in the work environment; 'confined' and inclined support surfaces; unexpected changes in roof surface properties; load handling; physical exertion; fatigue; task complexity that diverts workers' attention; individual differences; work experience and training; and personal protective equipment. Current measures to reduce falls from roofs focus mainly on fall protection procedures, such as the use of covers, guardrails, safety nets, and personal fall-arrest systems, or the application of warning-line systems, safety monitoring systems, and fall protection plans. In many instances, these procedures are not practical for the industry and current regulations allow the use of alternative means of fall protection, such as slide guards. Future research on preventing falls from roofs should consider the main effects and interactions of the environmental, task-related and personal factors that affect the balance control of workers. Research-supported improvements in the visual and physical characteristics of the roof work environment, the construction materials and methods, and work procedures and practices may result in improved workers' balance control as well as overall safety performance, and would ultimately reduce incidents of falling from a roof.