Despite recent changes in legislation and advances towards an integrated project-wide approach, health and safety management in the construction industry is still a major problem, involving a substantial cost to business, society and individuals. A prerequisite to improving the situation and developing an effective management strategy is monitoring, providing a detailed understanding of the effectiveness of different approaches to intervention. This paper describes a feasibility study using in-depth interviews with senior managers to explore the quality of accident and health data of nine large, high profile companies from the engineering construction sector. The interview dialogue comprised a series of questions and issues to be explored on the organization's accident reporting systems (e.g. what is reported, analysis performed, computerization), unsafe act and near miss auditing (e.g. definition, validity), failure type indicators (e.g. auditing, quantification) and safety culture indicators (e.g. commitment, health). Although safety was a priority for companies, health (i.e. medicals and monitoring systems) had not been given the same consideration, especially with regard to subcontracted labour. This study shows that the validity of accident statistics as a measure of safety remains a limitation, and that there is a requirement for a consistent and integrated approach to the measurement of health and safety performance.