(1) Background: The objectives of this systematic review were to (i) summarize the results of studies evaluating the reliability of observational ergonomics exposure assessment tools addressing exposure to physical risk factors associated with upper extremity musculoskeletal disorders (MSDs), and (ii) identify best practices for assessing the reliability of new observational exposure assessment tools. (2) Methods: A broad search was conducted in March 2020 of four academic databases: PubMed, Science Direct, Ergonomic Abstracts, and Web of Science. Articles were systematically excluded by removing redundant articles, examining titles and abstracts, assessing relevance to physical ergonomics and the upper extremities, and article type. (3) Results: Eleven articles were included in the review. The results indicated no singular best practice; instead, there were multiple methodological approaches researchers chose to use. Some of the significant variations in methodologies include the selection of reliability coefficients, rater and participant selection, and direct vs. digital observation. (4) Conclusion: The findings serve as a resource summarizing the reliability of existing observational risk assessment tools and identify common methods for assessing the reliability of new observational risk assessment tools. Limitations of this review include the number of databases searched, the removal of truncation symbols, and the selection of keywords used for the initial search.