Coal mining legislation makes frequent reference to ‘Safety Management Systems’ but there is a chronic shortage of useful guidance material as to how these might be applied to hazardous exposures. Several studies have indicated that for each death that is reported as a result of an industrial ‘accident’, there are five deaths that caused by occupational exposures. Because the deaths from occupational exposures do not occur on site and often well after employment has ceased, they are generally unreported. Improved access to mortality data from coroners, the Australian Institute of Health and Welfare and superannuation service providers (early claims from death and total permanent disability), has given rise to some analysis of death and disability data that provides evidence that there are emerging opportunities to develop and improve safety management systems for hazardous occupational exposures. Issues explored include how safety management systems might be developed in relation to dusts and chemicals and other hazardous exposures to ensure the risk of disorders with long latency periods are reliably assessed and the exposures effectively managed. The current standards and guidelines which refer to safety management systems in general or to management of exposure related hazards are examined. Many standards are based on dose-response studies that provide for an acceptable percentage of workers to suffer adverse health outcomes. An alternative management system might be to apply dose-response relations to health surveillance to identify ‘at risk’ individuals and effectively manage health and related safety risk at an early stage.