Drawing upon an empirical analysis of the design and construction of a food processing facility, a theoretical understanding of the impact of design decision-making on the occupational health and safety (OHS) of construction workers is developed. It is argued that current policy and legislative approaches to Construction Hazard Prevention through Design (CHPtD) are inherently limited because they do not adequately reflect the socio-material complexity of decision-making in construction design. Specifically, the simplistic attribution of responsibility to a single sociotechnical actor, 'the designer', does not reflect the multiple and disparate influences that impact upon OHS outcomes. Nor do existing CHPtD policy frameworks, management processes and tools, recognise the manner in which the interactions and associations between relevant project stakeholders and various non-human artefacts shape (and are also influenced by) the evolution of design decisions. Drawing on actor-network theory (ANT) and using embedded units within a case study approach, the interactions between human actors and non-human artefacts is explored in relation to the design of four components of the food processing facility. The way in which design decisions unfolded and shaped OHS experiences during the construction stage of the project is revealed. The research highlights limitations inherent in current approaches to the management of CHPtD and the need to develop a more robust theoretically-based approach to integrating OHS considerations into construction design practice.