Chinese contractors undertaking international projects are frequently criticized for their poor Occupational Health and Safety (OHS) performance. It is noticed that people with different occupations may perceive OHS differently. From a qualitative perspective, this study investigates the perceived OHS performances of design managers and construction managers engaged in Chinese overseas construction projects, considering a range of subgroups classified by people’s overseas experience, project size, project industry, project location, and firm size. The analysis was based on an e-questionnaire survey that sampled responses from 52 design managers and 160 construction managers involved in 110 international projects, and face-to-face interviews with 26 managers. The findings indicate that the assessment variation of OHS performance between design managers and construction managers is not only related to their different mental ways, but also can be mediated by their in-progress communication and affected by project and organizational conditions. The varying OHS performance in projects with different sizes or from different regions also suggests that Chinese contractors should be more proactive in OHS management instead of passively responding to external requirements.