The present review examines the link between Occupational Safety and Health (OSH) and economic performance, especially as it relates to small and medium sized enterprises (SMEs). It is essential to stress from the outset that while there is no clear definition of economic performance, there are indicators that can examine the concept and its importance to businesses. OSH is not usually viewed as a contributory factor to the economic viability of an organisation. Compliance with government guidelines, regulations and laws is generally the primary focus of OSH policies. Perceptions of the connection between effective OSH and the resulting financial benefits could, and should be improved. The strong economic advantages of good occupational health practice need to be highlighted continuously to organisations because the failure to acknowledge the importance of this link will limit the effectiveness of interventions aimed at preventing disease and injury (Lahiri, Levenstein, Nelson and Rosenberg, 2005; Toffel and Birkner, 2002). Additionally, while the cost of ensuring safety is important, “unsafety” is also costly (Rimington, 1993). For example, a reduction of accidents, damage and improvements to poor health can lead to a reduction in costs and a greater availability of people and plant. This, in turn, can improve efficiency and thereby heighten the effectiveness of businesses (Smallman and John, 2001).