This article addresses a gap in comparative research regarding the role of organisational factors in shaping occupational health and safety (OHS) outcomes when using temporary agency work (TAW). Using the Economic Pressures–Work Disorganisation–Regulatory Failure (PDR) framework, the article applies a comparative case study approach to analyse OHS outcomes in two sites of one multinational company. The findings reveal how differences in organisational practices embedded in different institutional contexts shape TAW use, influencing exposure to work-related injuries and exhaustion. These effects are particularly evident in the context of workforce segmentation, where trade-offs and unintended consequences emerge for the user firm.