Ergonomics must be integrated into a construction safety program to reduce the risks associated with musculoskeletal disorders. There is little guidance available on how ergonomics may be added to safety programs nor on the effectiveness of the additional ergonomic activities to reducing risks related to ergonomic exposures over time. This study illustrated the programmatic change process of adapting ergonomic activities into an existing safety management system of a single contractor, and the change in leading indicators, worker awareness, and observed behaviors over a 1.5 year period after delivering the revised program. The results showed improvement in worker awareness and in the leading indicators for attendance and number of trainings, discussion about ergonomics in safety meetings, and the frequency of identification of ergonomic hazards and controls on worker assessments and on management audits. These leading indicators provided information at interim points in time to indicate the need for additional programmatic changes. During this study, there was little change in observed behaviors. Integrating ergonomics into safety programs requires time and resources and change in work exposures occurs gradually over time.