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Purpose The purpose of this article is to determine safety culture indicators that can improve the health and safety performance of small and medium-sized enterprise (SME) contractors in Ghana. Design/methodology/approach A three-round Delphi method was used. The first round consisted of 31 experts out of which 18 of them rated their agreements with a set of 87 potential safety culture indicators using a 10-point Likert scale of importance (1 = important and 10 = very important) and the 16 experts who completed the final round were given the opportunity to suggest other indicators. The 87 indicators were categorised into 14 core health and safety elements. Indicators that attained a group median value of 5–10 for 50% or more expert ratings were accepted. Findings At the end of the third round, a consensus was reached on the indicators when they attracted median scores of 5–10 for at least 50% or more of the health and safety experts rated the indicators between 5 and 10. Out of a total of 87 indicators at the start of the Delphi process, the consensus was reached on 70 that were retained. Research limitations/implications The health and safety experts were not given the opportunity to add new indicators to the structured questionnaire until the third round. Originality/value This is the first study, to the best of the authors’ knowledge, to have a consensus by health and safety experts on leading indicator metrics of positive culture of construction safety in Ghana for improved SME construction company’s health and safety performance in Ghana. If these indicators are adopted and used effectively in Ghana, they would ensure positive culture of construction safety and subsequently help to protect construction workers.