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This paper is focused on identifying and analyzing the challenges and opportunities that North Macedonian companies faced while migrating from OHSAS 18001 to ISO 45001. The most common challenges identified were the lack of expertise, corporate culture, cost, low top management support and the redefinition of health. These challenges were pretty similar to the ones companies in other countries faced. On the other hand, there were opportunities that arose during this transition such as proactive approach and the redefinition of health, but there were some companies that didn’t recognize any opportunities. The proactive approach is one of the differencing elements between OHSAS 18001 and ISO 45001, which results in implementing preventive measures that lower the number of work-relatedinjuries, which is the main goal of any Occupational Health and Safety Management System.