Background: Providing occupational health and safety (OHS) services to employees has been a global problem for an extended period. A safe workplace should pose no avoidable risk to employees' physical, psychological, or social wellbeing and should provide opportunities for employees to improve and support their health. This study aimed to assess the occupational health and safety risks and hazards among workers at the construction sites in Kombo North District of the Gambia. Methods: A mixed-method study design was conducted across construction workers in Kombo North District, West Coast Region of the Gambia. Data was generated using validated OHS risk assessment matrix, structured questionnaires, environmental and physical inspection and key informant interviews. Descriptive statistics, including a composite scoring system, were used to present the results of this study. Results: Of the 157 respondents in this study, 98.1% were males, and about one-third of these construction workers were 31-40 years of age. About 46% and 34.4% spent 1-5 and 6-10 years in the construction industry, while about 40.2% of the respondents never been to school. The study revealed that physical risks and hazards in the form of falling from a height, electric shock, etc. were the most common forms compared to other categories such as ergonomics, biological and chemical risks and hazards. There is no reporting system or registry in place across the study sites. Conclusion: This study provides evidence that physical hazards reported being the most common across other forms of ergonomics, biological and chemical risk and hazards. There is an urgent need for reactivation and implementation of OHS advocacies, health education, and other preventive strategies to control common workplace risks and hazards in their various forms.