Prevention through Design (PtD) incorporates elements into building design that will reduce safety and health risks for the workers who will construct and maintain the building. In 2015, the US Green Building Council launched a PtD pilot credit as part of the LEED (Leadership in Energy and Environmental Design) certification program. The research team examined early implementation of the pilot credit. Using case studies of two European construction projects that pursued the credit, and surveys and interviews with domestic building industry stakeholders, they explored why U.S. adoption of the credit has been limited.