Underground coal mines, one of the most dangerous work environments, have experienced accidents and disasters. One of the main reasons for those unsafe events is the workers’ poor understanding of the hazards and risks of working in this work environment. Therefore, the present study aims to identify factors affecting the safety risk perception of underground coal mine workers in Iran and investigate their cause-and-effect relationships. By reviewing the literature, 40 variables were identified in five categories: individual, organizational, environmental, task, and external factors. The identified variables were ranked according to the expert group’s opinion in the form of a fuzzy Delphi study regarding their effects on risk perception. In the next step, 23 variables were selected to investigate the cause-and-effect relationships using the DEMATEL method. The study’s findings showed that organizational factors and some individual factors play a fundamental role in workers’ risk perception. The variables of safety culture, safety management style, and safety attitude had the most significant impact, and the variables of personal protective equipment and risk aversion had the smallest impact on workers’ risk perception. The present study’s findings can be used as a guideline to provide effective solutions for managers and workers in improving safety risk perception, subsequently reducing unsafe behaviors and increasing the safety status of underground coal mines.