Leading safety indicators assess construction behaviors and processes prior to the occurrence of safety breaches. These have emerged as a more effective alternative to traditional safety measurements in the construction industry. While exiting research has extensively defined these indicators and their correlation to safety performance, there is still insufficient understanding of their penetration on local and regional levels. This research aims to explore, define, evaluate, and provide guidance in relation to utilizing leading safety indicators in Tennessee. The interdependent research methodology incorporates (1) developing an industry questionnaire based on a comprehensive literature review, (2) disseminating the questionnaire to construction professionals in Tennessee, (3) analysing the results through a combination of descriptive and bivariate statistical analysis techniques, and finally (4) interpreting the results and drawing conclusions and recommendations. The survey results showed that over two thirds of the firms investigated used instituted systems of leading indicators. Yet, firms that had no knowledge of the concept or did not use it, still applied a wide range of practices similar to leading indicators. The most popular indicators amongst the studied firms were related to simple safety tasks and routine practices such as housekeeping, use of personal protective equipment (PPEs), and substance abuse programs. Conversely, more complex indicators related to strategic and policymaking programs, such as contractual safety obligations and evaluation of safety meetings and reporting systems, were less popular. Such complex practices were more likely to be used by larger companies over smaller ones. Following these findings of this research, and by repeating similar studies on other local and regional areas, more effective use of leading indicators can be achieved with greater understanding of current safety systems, contributing eventually to reaching a zero-accident construction industry.