Purpose: This study aims to explore the occupational health and safety risks associated with scaffolding work, to analyze the underlying causes of fall accidents, and to evaluate the economic impact such incidents have on construction companies. The study also aims to assess the cost-effectiveness of preventive safety investments by applying economic tools. Method: A mixed-method approach was used to address the study’s three research questions. The research began with a literature review to map the current state of knowledge regarding scaffolding risks, accident causation, and economic evaluations in construction safety. Data were collected through workplace observation and interviews with professionals from the industry. These qualitative insights were used to contextualize risk behaviors and organizational shortcomings. For the economic analysis, a case-based approach was adopted using real data from an inspection case by the Swedish Work Environment Authority. Two complementary models were applied: Return on Investment to assess short-term profitability, and Life Cycle Costing to estimate long-term cost implications of safety investments. Results: The results indicate that fall accidents from scaffolding are typically caused by a combination of technical failures, lack of updated risk assessments, insufficient safety follow-ups, and low adherence to routines. In several cases, workers consciously chose not to use fall protection, often due to perceived time pressure or a false sense of routine safety. The analysis showed that physical, hands-on training and clearly communicated responsibilities were perceived as more effective than digital education alone. ROI calculations demonstrated that even modest investments in training and equipment could yield high returns. For instance, a premium safety package combined with physical training produced an ROI of 913%, meaning every Swedish krona invested returned over nine kronor in avoided accident costs. The LCC analysis revealed that the total cost over a five-year period was over 50% higher in the scenario without preventive safety measures compared to the one with such measures. Conclusions: The study concludes that preventive safety efforts in scaffolding work are not only effective in mitigating risk but also financially sound. Combining ROI and LCC provides a comprehensive understanding of both short- and long-term financial consequences. These tools support more informed decision-making in occupational safety management and emphasize that investing in safety is both a moral and economic imperative.