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Global warming will increase heat stress at home and at work. Few studies have addressed the health consequences in tropical low and middle income settings such as Thailand. We report on the association between heat stress and workplace injury among workers enrolled in the large national Thai Cohort Study in 2005 (N= 58,495). We used logistic regression to relate heat stress and occupational injury separately for males and females, adjusting for covariate effects of age, income, education, alcohol, smoking, Body Mass Index, job location, job type, sleeping hours, existing illness, and having to work very fast. Nearly 20% of workers experienced occupational heat stress which strongly and significantly associated with occupational injury (adjusted OR 2.12, 95% CI 1.87–2.42 for males and 1.89, 95% CI 1.64–2.18 for females). This study provides evidence connecting heat stress and occupational injury in tropical Thailand and also identifies several factors that increase heat exposure. The findings will be useful for policy makers to consider workrelated heat stress problems in tropical Thailand and to develop an occupational health and safety program which is urgently needed given the looming threat of global warming.