Escherichia coli O157:H7 is a cause of foodborne disease and global public health issues especially in developing countries like Ethiopia. A cross sectional study was done from January 2022 to July 2022 in Awi Zone to assess the occurrence and antibiograms of E. coli O157:H7. Abattoirs and butcher shops were selected purposively, whereas a systematic random and purposive sampling technique was employed to select study units in abattoirs and butcher shops respectively. A total of 248 swab samples were collected, isolated, and confirmed using bacteriological culture, biochemical tests, and latex agglutination tests. E. coli O1157: H7 antibiogram tests were performed using Kirby Bauer disk diffusion method. A questionnaire survey was used to assess abattoirs and butcher shop workers' knowledge, attitudes, and hygiene practices towards meat hygiene. Logistic regression was used to analyze and measure the degree of association between the presumed risk factors and E. coli O157:H7 occurrence. The overall occurrence of E. coli O157:H7 was estimated to be 8.87% and a relative higher (11.29%) occurrence of E. coli O157:H7 was recorded at butcher shops when compared to abattoirs (6.45%). All isolates were susceptible to gentamicin followed by chloramphenicol (81.81%). About 81.81% of the isolates were resistant to ampicillin and 77.23% of isolates were developed MDR. About 74.19% of abattoir workers were never heard E. coli O157:H7 as a causative agent for foodborne disease and 9.67% butcher shop workers have no information about the ways of meat contamination. About 90.32% abattoir and all butcher shop workers wear appropriate personal protective equipment and aprons & hair cover respectively. Inconclusion, E. coli O157:H7 was detected in the study area. Thus, educating abattoir and butcher shop workers, and consumers, on hygienic handling practices and safe consumption of meat could eliminate foodborne infection associated with E. coli O157:H7 occurrence.