Background: Small and medium-sized enterprises (SMEs) include a large part of manufacturing jobs and play an important role in developing national economics and employment. Objectives: The present study aimed to investigate occupational health problems and safety conditions among SMEs in Shiraz, Iran. Methods: This cross-sectional study was carried out on 711 SMEs, including 371 small enterprises (fewer than 25 workers) and 340 medium enterprises (25-99 workers), in Shiraz, Iran. The participants were selected randomly among the workplaces under the coverage of social security insurance. The researcher-made questionnaire, which consisted of demographic characteristics, the frequency rate of occupational accidents, and exposure to workplace harmful agents, were distributed among participants. Findings: The results showed there were significantly more physical and chemical harmful agents in medium enterprises compared to small ones (P < 0.001). However, the frequency rate of accidents in small enterprises was significantly higher than in medium enterprises (P < 0.001). Also, there was no significant difference between the studied enterprises in ergonomic hazards, except for awkward posture, whose frequency rate was significantly higher in small enterprises (P < 0.05). Finally, among the reported symptoms, the prevalence of eye, skin, ear, and respiratory symptoms was significantly higher in medium enterprises compared to small enterprises (P < 0.05). Conclusions: Occupational health and safety (OHS) regulations in medium enterprises have led to improved OHS conditions compared to small enterprises. Therefore, small enterprises should be included in OHS regulations.
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