We examine the potential effectiveness of key provisions of the Québec prevention regime as reformed by the Act to modernize the occupational health and safety regime (AMOHS) in September 2021. We expand Tucker’s (2007) two-axis typology characterizing citizenship at work to include a perspective sensitive to gender and to other sources of inequalities such as class and race. In this expanded model, the right to representative participation, worker influence and internal control extends to all workers (regardless of employment status), and includes accountability along value chains. In the expanded model,risks addressed by the prevention regime, and subject to external control, include often invisibilized risks associated with women's work. In the face of opposition to the initial reform bill, which underestimated the risks associated with women's work, adoption of key elements of the reform – the provisions on preventive and participatory mechanisms – was postponed and an interim regime established. The AMOHS will eventually allow for worker participation mechanisms aimed at increasing internal control in all sectors. This, however, comes with a risk that internal control will result in cosmetic rather than substantive compliance, lead to inconsistent levels of worker influence and undermine some of the conditions that underpin effective participation mechanisms, especially for non-unionized workers and those in small establishments. Further, the Public Health network has lost systematic access to workplaces, and it is not known what resources will be available to it or to the inspectorate. It remains to be seen whether the ongoing joint regulatory process to determine future preventive and participatory mechanisms will strengthen prevention and at the same time bolster, rather than weaken, citizenship at work.