Malaysian economy depends heavily on the contribution of the construction industry. This sector contributes to high occupational fatalities in Malaysia. Immediate (human and worksite) and underlying (management and external) causes contribute to occupational accidents and illnesses. The study’s main aim is to analyse local construction personnel’s perspective on the causes (immediate and underlying) of Malaysian construction accidents and illnesses. 13 housing projects were selected in Pulau Pinang. A survey questionnaire supported by in-depth interviews was conducted. The immediate causes comprising human and worksite elements were perceived as most significant, with mean values of 3.45 and 3.58, respectively. Significant correlations between the two-level of causes (immediate and underlying) are registered in the study. The effect on construction accidents and illnesses derived from underlying causes is not as obvious as the impact of human and worksite elements.