To describe the health and occupational risks of informal waste workers (IWW) in the Kathmandu valley and explore factors associated with not using personal protective equipment (PPE). Study Design A cross-sectional survey of IWWs. Method Data was collected on the health and occupational risks of adult IWWs working on waste sites in the Kathmandu Valley and in the adjacent Nuwakot District, Nepal in November 2017, through convenience sampling. Using a standardized health assessment questionnaire, face to face interviews were undertaken to record sociodemographic data, indicators of general and occupational health, data on healthcare access and use, physical risks, perception of occupational risks and use of PPE. Associations between use of PPE and gender, age, education, country of origin, injury and perception of occupational risks were examined using multivariate logistic regression analyses. Results In 1278 surveyed IWWs, prevalent physical risks included injuries (66.2% in the previous 12 months) and the main reported symptoms were respiratory in nature (69.9% in the previous 3 months). Most prevalent injuries were glass cuts (44.4%) and metal cuts (43.9%). Less than half of IWWs (46.8%) had been vaccinated against Tetanus and 7.5% against Hepatitis B. 72.5% of IWWs considered their work as 'risky', but 67.6% did not use PPE. Non-use of PPE was independently associated with male gender (odds ratio [OR] 2.19; p <0.001), Indian origin (OR 1.35; p=0.018), older age (OR 2.97 for over 55 years old; p=0.007) and low perception of occupational risks (OR 2.41; p<0.001). Low perception of occupational risk was associated with older age (55+ years) and lack of receipt of information on the risks. Conclusion IWWs are at increased risk of injury in their work, yet are poorly protected in relation to vaccine-preventable infections and work wear. The results suggest that information is important in relation to perception of occupational risk, which in turn is associated with the use of PPE. There is a need for policymakers and public health practitioners to have a robust understanding of the needs and vulnerabilities of this group, as well as identify effective interventions that can be taken to safeguard the health and welfare of IWWs.