Due to the significant change in business organizations, scholarly interest has diverted from studying the determinants of financial performance to understanding the environmental activities, sustainability practices, and health and safety management practices. Despite the extensive literature, it is yet to understand either internal or external factors that improve health and safety management practices in SMEs. This research examines the influence of the internal factors—intellectual capital, information technology capabilities (ITC), and entrepreneurial orientation, and the external capabilities—government financial support, institutional pressure, and managerial networking on six health and safety management practices: management commitment, staff training, worker involvement, safety communication and feedback, safety rules and procedures, and safety promotion policies. We researched 410 Pakistani SMEs from the food business industry. The results indicate that intellectual capital significantly improves management commitment, safety communication and feedback, and safety rules and produces; ITC significantly improves management commitment and safety communication and feedback; and entrepreneurial orientation significantly facilitates safety training and worker involvement only. In the external capabilities, government financial support has a significant influence on management commitment, worker involvement, safety rules and policies, and safety promotion policies. Institutional pressure has a significant influence on management commitment, safety training, safety communication, and feedback and safety promotion policies. Managerial networking significantly influences safety training, worker involvement, safety rules and procedures, and safety promotion policies of SMEs. Focusing only on the food industry is the major limitation of this research, this study recommends SMEs to give sufficient attention to their internal and external factors to enhance health and safety management practices. Further implications are discussed.