Fishing is a well-known industry, and there are certain risks of work-related diseases and accidents, occupational hazards and safety issues. This study aimed at examining the determinants of occupational hazards and injuries among fishermen at Tanji fishing site, a major fish-landing site in the Gambia, West Africa. An analytical cross-sectional design was conducted in August to October 2019. Structured questionnaires were administered to fishermen at Tanji fishing site. A simple random sampling method was used to select fishermen in this study. Data entry and processing for preliminary data analysis was done using Stata version 15. Descriptive and bivariate analysis using chi-square/fisher exact test as well as binary logistics regression analysis were used. The adjusted risk ratios (aRRs) and confidence intervals of 95% were calculated. A P-value < .05 was considered for statistical significance. The proportion of occupational hazards were 95%, while reported injuries were 85%. Ergonomics, physical, and environmental/climatic hazards formed the majority at 25%, 23%, and, 21%, while muscle strains and falling formed the majority for types of injuries at 19% and 17%, respectively. Fishermen who used PPE (aRR: 0.12and 95% CI: 0.01-0.99) were less likely to have occupational hazards relative to those who did not use PPE. In terms of injuries, fishermen who were smokers (aRR: 3.18, 95% CI: 1.32-7.66), had chemical hazards (aRR: 3.14, 95% CI: 1.26-7.86) and had no fishing safety rules (aRR: 2.81, 95% CI: 1.15-6.85) were more likely to sustained injuries relative to other categories after controlling for confounders. This research found a high prevalence of OSH hazards and injuries among fishermen, highlighting the critical nature of strengthening safety regulatory services for this workforce.