This study investigated the implementation of the occupational safety and health (OSH) risk management system, known as the Hazard Identification, Risk Assessment and Risk Control (HIRARC), in small-medium enterprises (SMEs) in Malaysia. Specifically, the implementation of the HIRARC system’s challenges and weaknesses faced by SMEs were investigated based on a systematic literature review of two databases, namely SCOPUS and Google Scholar. The results show that there was scant work on the HIRARC system implementation and limited specific industries, such as construction and production. Additionally, the challenges faced by SMEs were categorised into the HIRARC system’s weaknesses and the organisation’s inadequacy in implementing the system. This study provided implications to the OSH regulators in continuously promoting the HIRARC system’s significance while improving the system and encourage its assimilation among SMEs in Malaysia. This study is also hoped to provide some guidance to the SMEs in Malaysia in implementing OSH risk management system.