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The construction industry presents significant high risks of injury and fatality to its workforce. Adopting prevention through design (PtD) principles is reported to have high potential for mitigating such risks and improving safety outcomes. PtD seeks to assess and reduce workplace hazards during the design phase, minimizing unsafe construction conditions. Despite its potential benefits, the construction industry encounters challenges in effectively utilizing PtD. Thus, the implementation of PtD in the US construction industry is limited, and designers' awareness remains low. This evident lack of utilization warrants further examination of the contributing factors. The goal of this study is to identify and rank PtD utilization barriers in the United States (US) construction industry. This study pinpointed 12 pivotal barriers to PtD implementation through a systematic literature review. These barriers were categorized into industry-, project-, designer-, and client-related domains. Furthermore, they were grouped into three clusters based on their influence on PtD implementation from the most to the least influence, based on an expert matter questionnaire. This study also compared the experts' rankings of the identified barriers with their citation frequencies in the reviewed articles. Among other observations, this study found that the lack of PtD professional training and formal education for project stakeholders negatively impacts the likelihood of PtD utilization and exacerbates several other barriers. Therefore, it is advisable to prioritize addressing this barrier by allocating the necessary resources and efforts to efficiently address it. Construction industry stakeholders with a vested interest in advancing PtD applications are encouraged to leverage the insights this study provides to expedite the adoption of PtD. [ABSTRACT FROM AUTHOR]