Background: Wastewater treatment plant (WWTP) is considered one of the most treacherous sectors in the industrial field. Many workers still die each year due to poor awareness of workers about occupational health hazards. Aim: to assess prevalence and determinants of occupational health hazards among sewage workers in El-Beheira Governorate. Design: A cross sectional descriptive design was used. Setting: The study was conducted in all sewage water treatment stations in 14 Administrative centers in El-Beheira governorate which including 32 stations. Subjects: a convenient sample was used to select 400 sewage workers in the previously mentioned settings. Tools for data collection: Three tools were used for data collection, Tool (I): Sewage Workers Structural InterviewQuestionnaire, part socio-demographic characteristic of workers. Part (2) working profile related to workers. Part (3) Workers' occupational hazards knowledgestructured interview sheet. Part (4) Worker's health status assessment sheet. Tool (II) Observational checklist of sewage workers regarding safety and health at work. It is composed of (5) parts. Tool (III) Workplace Stress Scale consists of (8) items that were used to measure job stress levels. Results: the studied workers wereexposed to high levels of chemical hazards followed by biological, physical, and mechanical hazards. Skin problems were the common health problems, followed by respiratory problems and GIT problems. The main risk factors that affect workers health and safety were age, income, number of family members, years of experience, absenteeism at work, and presence of health clinic at workplace. Conclusion: most of the workers had a poor level of knowledge regarding occupational health hazards and personal protective equipment so most of them were exposed to all types of occupational hazards. Recommendations: Healthprograms should be conducted for both the workers and the relevant authorities regarding occupational health hazards and its prevention. Implement a standardized occupational health problems screening strategy and follow up visits. Periodic teaching programs to provide workers with adequate knowledge.