Background According to the previous studies, the work-related accident rate decreased in Korea after the introduction of occupational health and safety management system (OHSMS), but there were several disasters in Korea such as subway worker's death at Guui station in 2016 and the Taean thermal power plant accident in 2018, which escalated the social demand for safety. In 2018, OHSMS became an international standard, as ISO45001 was announced. Methods A survey was conducted to research the implementation status of OHSMS and changes in people's perception, and the results were compared with those of a past survey. Results Enhanced social demand and various stakeholders' (not only buyer) needs, and social responsibility are perceived as the motivation for the introduction of OHSMS rather than legal compliance or customer demand. In the questionnaire about problems with the implementation of OHSMS, the factors with higher response rate in 2018 than 2004 were “excessive cost” and “complicated documentation management.” In the questionnaire about how to promote OHSMS in organizations, most people answered “reduction of workers' compensation insurance rate” in 2004, but most people answered “exemption from health and safety supervision” in 2018. Conclusion For the effective implementation of ISO45001, emphasis is placed on social demand, training to recognize health and safety as a part of management, and the reduction of certification and consulting costs to promote the introduction of OHSMS. Incentives such as insurance premium cuts and exemptions from health and safety supervision are needed.