The construction industry has been seen as one of the hazardous industries. This is because the industry has a poor health and safety performance record compared to other industries all over the world. Labor law in every nation provides that it is the duty of an employer to ensure that every worker employed works under satisfactory, safe and healthy conditions. The research is focused on evaluating the health and safety issues in building construction projects in Addis Ababa, Ethiopia. The roles of the Client, Consultant and Contractor in health and safety consideration during project implementation were examined. It also determined the factors affecting health and safety performance of laborers. Whether, safety is used as criteria in selecting a contractor during the prequalification phase of public bidding was also identified. Building Construction Companies were involved in the sampling. All the information that could help in attaining the study objectives were collected, reviewed and formalized from the literature review. Data were collected and evaluated and the Relative Importance Index for each factor affecting health and safety was determined. The study determined the practical situation of building construction projects in consideration of health and safety, which was evaluated as low to medium. Relative Importance (RII) index of 12 factors affecting health and safety performance of labors were calculated. The top three factors identified were: (1) Non availability of a clear company Health and safety policy (0.85); (2) Inadequate enforcement of the existing building rules and regulations (0.82); and (3) Safety awareness of the company's top management (0.80). To improve the safety and health performance of building construction projects, the following major recommendations were proposed: each building, construction projects should have their own safety and health policy; include safety as a pay item in contract document; and allocate budget and time frames for health and safety in the contract document. Index Terms— Addis Ababa, Company Policies, Hazards, Health and Safety Practices, Rules and Regulations .