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Abstract Climate change poses escalating risks to labor-intensive industries in South Asia. This mixed‑methods study assessed how climate‑related hazards affect the health, safety and productivity of workers in Sri Lankan small‑ and medium‑scale apparel manufacturing companies (SMAMCs). A survey of 384 employees in Biyagama and Katunayake Export Processing Zones captured quantitative data on exposure to excessive heat, flooding, indoor air pollution and mosquito‑borne diseases, and elicited qualitative accounts of workplace experiences. Heat waves and high humidity were the most pervasive stressors: 81.25% (95% CI; 77.3 to 85.2) of respondents reported heat stress, with headaches, dehydration, and diminished concentration frequently linked to needle‑prick injuries. Flood events damaged infrastructure and heightened respiratory, gastrointestinal and dermatological illnesses, while inadequate ventilation compounded air‑quality problems; 95% (95% CI; 92.4 to 96.8) of workers complained of persistent coughing. Dengue incidence over the preceding five years reached 10.68% (95% CI; 8.0 to 14.2), reflecting expanding vector habitats. Chi‑square analysis confirmed statistically significant associations between each hazard and adverse health outcomes. The study underscores the need for integrated adaptation measures, improved ventilation, low‑cost cooling, drainage upgrades and systematic vector control, supported by enforceable regulations and targeted financial assistance. Enhancing climate resilience in SMAMCs is essential for safeguarding worker wellbeing and sustaining Sri Lanka’s export competitiveness, while contributing to global goals on decent work and climate action targets.