The rail construction industry is notable for its large scale, substantial investment, extensive stakeholders involvement, long construction period, and intricate operation and technology. This industry is among the most dangerous due to the highest number of occupational accident cases worldwide. Therefore, it is crucial to analyse and identify the existing literature on occupational accident factors in rail construction. To address the research aim, the study identified the factors that contribute to occupational accidents using systematic review methodology. This systematic literature review adheres to the rigorous Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 statement. Relevant publications from the past 25 years were retrieved from Scopus, Web of Science (WoS), and Science Direct electronic databases. Through a meticulous review of 43 selected publications, five accident factor themes were discovered: worker, workplace, materials and equipment, organizational, and environmental influences. The detailed analysis of these themes has led to the identification of 19 specific sub-factors within these categories, providing a granular understanding of the intricate elements contributing to accidents. This study offers a foundational understanding of accident factors in the rail construction industry, paving the way for targeted OSH interventions aimed at preventing occupational accidents in the future.