PurposeThis study examines the implementation and performance of Occupational Health and Safety (OHS) practices in the Pokhara Regional International Airport Project (PRIAP), a key public infrastructure initiative in Nepal. Given airports' significance to Nepal’s economy, particularly for tourism and trade, the research highlights the unique safety challenges in airport construction, addressing gaps in OHS management in developing countries.Design/methodology/approachA case study methodology focused on the PRIAP enabled a thorough analysis of safety practices. Data were gathered using structured questionnaires from various stakeholders. The Cronbach’s alpha and relative importance index (RII) were used to assess response reliability and ranked factors affecting safety performance.FindingsThe study identifies both strengths and weaknesses in the project’s OHS practices. While plant and equipment handling and financial aspects, such as budget allocation for safety measures and accident compensation, were deemed satisfactory, significant deficiencies were found in hazard identification and the investigation of near misses. These results suggest that improvements are needed in proactive safety management, particularly in worker-management communication.Research limitations/implicationsThis study provides valuable insights but is limited by its single-site focus and use of descriptive statistics. Future research should employ advanced statistical methods, like ANOVA, and include multiple construction sites to capture a broader range of OHS challenges. Evaluating the long-term effectiveness of proposed interventions is also essential. Addressing these limitations will enhance the development of comprehensive safety management strategies tailored to the specific needs of construction projects in developing countries.Practical implicationsThis study provides practical recommendations for improving OHS practices in airport construction and similar large-scale projects in developing countries. Enhanced hazard identification and improved communication among stakeholders can help reduce accidents and boost project efficiency.Social implicationsImproving safety regulations and culture can reduce workplace injuries, enhancing workers' well-being and quality of life. This research supports stronger public policies, helping lower economic burdens from accidents, promoting social stability and increasing public trust in regulatory bodies.Originality/valueThis research contributes to the limited literature on OHS in airport construction projects in developing countries, particularly in Nepal. The case study methodology provides a detailed examination of safety practices and offers a framework for improving OHS in similar projects.