Water, wastewater and sanitation (WASH) infrastructure are essential for society and the construction and rehabilitation of WASH facilities are one of the priorities for governments worldwide. However, WASH projects remain fraught with uncertainties and risk management during the preconstruction stages of these projects is not well documented, leading to poor project implementation and decreased climate change adaptation. This study thus aims to bridge this gap by identifying risk factors that occur during the pre-construction stages in Small Island Developing States (SIDS). Through an extensive literature review, risk factors for infrastructure projects in their planning, design and procurement phases were obtained and refined for the SIDS context through expert interviews. A questionnaire survey was then designed and distributed to sixty-eight respondents, working in parastatal institutions, engineering consultants and contracting firms. The ranking of risk factors was calculated using the RII method for the different lifecycle stages. Participants identified funding issues (RII: 0.850), political interference (RII: 0.847) and lack of stakeholder coordination (RII: 0.838) as the three most important risks in the planning stage while insufficient time and resources (RII: 0.806), poor scope definition (RII: 0.800) and lack of technical expertise (RII: 0.794) constituted major risks in the design phase. For the procurement stage, inadequate specifications to cater for climate change (RII: 0.812), insufficient resources for bid preparation (RII: 0.803) and lack of competency of bidders (RII: 0.803) represented significant risk factors according to respondents. The most critical risks identified for each stage were used to formulate a risk checklist for pre-construction stages of WASH projects, thus addressing the lack of risk management documentation in SIDS. The checklist can be applied by professionals in water and wastewater projects to improve the management of projects and ensure more effective implementation and greater climate change adaptation in SIDS.