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The rate of construction accidents in the Ghanaian construction industry is not encouraging. The study sought to identify the factors affecting the effective health and safety practices in the construction industry within the Cape Coast Metropolis. Purposive sampling technique was used to select the construction firms and ‘Yamane formula’ to arrive at the number of respondents (44) for the study. Structured questionnaires were distributed among site engineers, site supervisors, safety officers, quantity surveyors, foremen, chief masons and chief carpenters. Statistical Packages for the Social Sciences (SPSS) was used for the data analysis and results were presented in a form of descriptive and inferential statistics. Findings show that the level of health and safety practices within the Metropolis was high and the factors that affected the implementation of health and safety programmes were severe among the firms. Few of the company’s health and safety programmes were effective and this calls for the strengthenig of the construction sector policy by the ministries responsible for implementation.