IntroductionInformation regarding workers’ practices concerning safety measures in Ethiopia’s sugar industries is inadequate.ObjectivesTo assess occupational health and safety practices and associated factors among workers in Ethiopia’s Metehara and Wonji sugar industries.DesignA convergent parallel mixed design.SettingMetehara and Wonji sugar industries in Ethiopia (December 2021 through May 2022).ParticipantsWe used a stratified random sampling method to select 1648 participants for the collection of quantitative data. We employed a purposive sampling method to carry out 20 in-depth interviews in order to gather qualitative data.Primary outcome measuresWe computed the extent of occupational health and safety practices using a 21-item questionnaire. Finally, results were graded as ‘good’ if ≥60% of them were answered correctly and ‘poor’ if <60% were correctly answered. We created a qualitative data interpretation from the subject’s perspective.ResultsThe percentage of good occupational health and safety practices was 29.6% (95% CI: 27% to 32%). Inappropriate provision of personal protective equipment (adjusted OR (AOR)=1.42, 95% CI: 1.10 to 1.83), a lack of strict safety regulation (AOR=1.64, 95% CI: 1.27 to 2.12), a lack of incentives (AOR=1.31, 95% CI: 1.04 to 1.66) and inadequate management support (AOR=1.19, 95% CI: 1.04 to 1.66) were identified as associated factors. Health service usage defects, inappropriate protective equipment use and failure to follow occupational safety commands were identified as challenges.ConclusionsOccupational health and safety measures were not used effectively. The qualitative component of this study confirmed that most participants expressed undesirable practices in occupational health and safety measures. Inappropriate protective device provisions, a lack of strict safety regulation, the absence of incentives and inadequate management support were found to be linked with the use of occupational health and safety measures. The contributing factors we identified potentially indicate areas for future intervention.