Summer extreme heat threatens the health of individuals, especially persons who are involved in outdoor activities. Ensuring the normal function of a city, bus drivers are among those who participate in outdoor physical activities and are exposed to excessive heat in hot summer weather. This qualitative study was performed to explore professional bus drivers' in-depth views of extreme heat risks to their health, and ultimately develop targeted advice and policy interventions for city bus drivers. An interview-based study was performed among professional bus drivers in Jinan, China, including four focus groups with professional bus drivers (n = 37) and three interviews with their managers (n = 14). Five central themes or categories from the bus driver interviews were found: concerns about summer heat; health effects related to extreme heat; adaptive measures; barriers in implementing these adaptive measures; and suggested interventions. The beneficial role of cooling facilities (particularly air-conditioning) during extreme heat are addressed. The barriers not only impede the implementation of behavioral adaptive measures but also enhance the negative attitudes of bus drivers towards their effectiveness. The responsibilities of managers in promoting preventive actions are addressed.