The development of exertional heat illness (EHI) is a health, welfare and performance concern for racehorses. However, there has been limited multivariable assessment of the possible risk factors for EHI in racehorses, despite such information being vital for regulators to effectively manage the condition. Consequently, this study aimed to identify the risk factors associated with the occurrence of EHI in Thoroughbred racehorses and assess the ability of the risk factor model to predict the occurrence of EHI in racehorses to assist in early identification. Runners at British racecourses recorded in the British Horseracing Authority database between 1st July 2010 and 30th April 2018 were used to model the probability that a horse would present with EHI as a function of a suite of environmental, horse level and race level factors. EHI was reported in 0.1% of runners. Race distance, wet bulb globe temperature, preceding 5-day temperature average, occurrence of a previous EHI incident, going, year and race off time were identified as risk factors for EHI. The model performed better than chance in classifying incidents with a mean area under the receiver operating characteristic curve score of 0.884 (SD = 0.02) but had a large number of false positives. The results provide vital evidence for industry on the need to provide appropriate cool down facilities, identify horses that have repeated EHI incidents for early intervention, and collect new data streams such as on course wet bulb globe temperature measurements. The results are especially relevant as the sport is operating in a changing climate and must mitigate against more extreme and longer spells of hot weather.