Objectives A considerable effort has been made to examine the health and safety of employees in large-sized enterprises. However, there has not been much attention given to the organisation of work, occupational health and safety, and work disability prevention in small and medium enterprises (SME). The purpose of our study is to examine facilitators and barriers to occupational health and safety among SME in Ontario.

Method A cross-sectional design was used to examine the occupational health and safety culture of small and medium sized enterprises from public and private sectors in Ontario. A convenience sample of employees from all position titles in Ontario organisations that ranged from 5 to 100 full-time equivalent employees were invited via email to participate in the survey.

Results A total of a 153 questionnaires were returned. Most of the respondents were female (84.2%) with a mean age of 49.8 years (SD = 10.6). Multivariable logistic regression modelling revealed the odds of a safe work environment for SME who conducted regular safety inspections were estimated to be 2.88 (95% CI, 1.57–5.27) greater than the odds of a safe work environment for SME who did not conduct regular safety inspections.

Conclusions This study profiled the work and safety among small and medium enterprises in Ontario. Moreover, better implementation and training strategies that focus on adapting occupational health and safety legislation to the nature and diversity of SMEs is warranted.