Construction projects constitute complex and dynamic systems, which pose high health and safety risks to the practitioners. As a result, many researchers have underscored the importance of risk management that requires inputs from all stakeholders across different stages of the construction project from the design up to the construction phase. However, there is a limited knowledge about stakeholders' influence on health and safety risk management in building construction projects in Tanzania. To fill this gap, a case study approach was employed to analyse three large ongoing construction projects in Dar es Salaam in Tanzania. Data were collected through questionnaire survey and in-depth interview with a range of stakeholders: clients, consultants, contractors, workers and regulatory agencies. From the findings and with reference to literature, the systems thinking approach was used to develop a model showing the stakeholders' influence on health and safety risk management. The pattern of relationships between different stakeholders and the capacity of the system to offer health and safety control was traced using the results of the case studies of the three projects. The study confirms that there is a link chain relationship when stakeholders influence the health and safety risk management at the following stages of the construction projects in Tanzania.