About two million workers die prematurely every year from occupational illnesses, and more than eighty percent of occupational injuries occur in developing countries like Ethiopia. The objectives of this study were to assess the level of occupational safety and health management system implementation, safety measures, awareness of workers, and workplace hazards and risks. A mixed research methods study was conducted. The quantitative data were collected by using a pilot tested questionnaire from 120 randomly selected tannery workers, and the qualitative data were gathered from eight tannery workers and three key informants through interviews. The result of this study showed that there was no occupational safety and health management system in the leather tannery (75.8%). Tannery workers never used protective equipment at their workplace (90.8%) due to unavailability of the equipment (85.0%). They had also poor awareness on occupational safety and health (62.5%). Workers were exposed to workplace and ergonomic hazards (66.6%), physical hazards (68.4%), chemical hazards (56.7%), biological hazards (35.0%), and psychosocial hazards (70.0%). As well, workers were suffered from skin diseases (45.7%), respiratory problem (11.3%), gastrointestinal problems (10.6%), and jaundice (9.0%). Occupational health risks have a significant association with educational level, occupational safety and health management system, and awareness of workers (p<0.05). It implies that the tannery industry is a place where several employees suffered from different health problems due to improper implementation of the labour law. This pave the way for social work practitioners to put their