Container terminals are purpose built or substantially adapted ports virtually exclusively involved with the transport of containerised goods. They now exist everywhere and have redesigned dock-work to increase productivity and efficiencies in the handling of goods, making physical handling by dock-workers increasingly redundant. Conventional wisdom suggests that arrangements for the safety and health of those who remain in employment are generally improved in comparison with past conditions. Yet, reliable evidence of the effects of work on the occupational safety and health (OSH) of these workers is scarce. This paper is based on research which examined the OSH experiences of workers involved with operational tasks in terminals operated by global network terminal (GNT) companies in four countries situated in Asia-Pacific and Europe. It explored these experiences along with the respondents’ perceptions concerning the effectiveness of arrangements made to manage their OSH risks, and compared findings between countries. The research demonstrated a significant gap between managers’ understandings of the operation of arrangements for OSH and the perceptions and experiences of workers, both in relation to OSH outcomes and the effectiveness of the OSH arrangements. This was especially evident for work-related ill-health, workers’ representation and consultation on OSH, and in the differences in the experience of all these between directly employed workers and those employed by contractors. The paper discusses the implications for improved OSH arrangements and outcomes.