Small and medium sized businesses (SMBs) play an important role in boosting economic growth and providing employment around the globe, including in Indonesia. According to a recent report by the Ministry of Cooperatives and Small and Medium sized Businesses, one of the fastest growing industries among SMBs in Indonesia is manufacturing. However, the manufacturing industry also accounts for a high number of workplace injuries and often faces challenges to implementing occupational safety and health (OSH) programs. As the manufacturing industry continues to grow in Indonesia, it is important to understand how OSH programs can be implemented in these businesses. This study examined the perceptions of business owners, employees, and relevant stakeholders towards OSH implementation through in-depth interviews. In addition, by utilizing focus group discussions, this study also discussed strategies to implement OSH programs in small and medium sized manufacturing businesses in Indonesia. The findings from the in-depth interviews with business owners and stakeholders (e.g., Ministry of Manpower, Ministry of Health, National Insurance Agency, National Agency of Drug and Food Control, International Labor Organization, business owners’ association, and a local non-profit organization) showed that there were deep gaps in national policies, as well as owner awareness and implementation, of OSH programs in SMBs in Indonesia. There was also a tendency of business owners to shift responsibility of occupational injuries to the employees, as well as deferment of OSH responsibility from national stakeholders to business owners. In addition, results of the in-depth interviews with the small and medium sized business employees showed that employees had health and safety concerns in their workplaces but viii chose not to express them to the business owners because they felt the owners were in a position that deserved their respect. Small and medium sized businesses often have close relationships between business owners and employees, which may explain in part why employees did not express their safety concerns. This relationship could also be a reason employees do not seem to mind the absence of written OSH policies and procedures or the lack of employer-provided medical insurance. Further, despite experiencing injuries, employees internalized what business owners told them about simply needing to be more careful to ensure their safety at work. Findings from the in-depth interviews with business owners, relevant stakeholders, and employees were utilized to develop a basic OSH program plan with low-cost and no-cost strategies for small and medium-sized businesses in Indonesia to implement. Focus group discussions with small and medium sized business owners and stakeholders were then conducted to identify the practicality and acceptability of the program plan. Results showed that participants suggested some key strategies to increase the success of implementing the OSH program in small and medium sized businesses in Indonesia, including integration of the OSH program with the existing certification program from the National Agency of Drug and Food Control and integration through occupational health unit from the local public health centers.