This study aimed to examine Occupational Safety and Health (OSH) Compliance in the Artisanal Small-Scale Gold Mining (ASGM) sector in Ghana with a focus on Adadiem and identify the challenges associated with it. A quantitative research method was employed and all 248 survey respondents were sampled. The study revealed a lack of compliance with OSH practices, and “hit by working tools” and slipping/falling were identified as the most common types of safety hazards leading to minor injuries in the ASGM industry. It was also observed that working tools and machinery are the main sources of injuries and mostly affect the legs, knees, and feet. The findings of the study indicate the presence of OSH breaches in the ASGM industry in the study area. It is therefore proposed that the government of Ghana create and enforce legislation that places stringent requirements on ASGM operators to ensure that they are meeting OSH standards and protecting the health and safety of their workers, and that policy tools such as fines, taxes, restrictions, and subsidies may be employed to promote compliance with safety requirements.