Trichloroethylene (TCE) is an important volatile organic compound once widely used in industry throughout the world. Occupational exposure to TCE can cause a number of health hazards such as allergic reactions and genetic damage. The purpose of this study was to evaluate occupational exposure to TCE, by analysis of the air in the breathing zone and of urine from workers employed in a clock manufacturing factory. A subjective symptom survey was conducted by using a self-administered questionnaire to evaluate the health hazards. Micronucleus (MN) frequency, based on the cytokinesis-block micronucleus assay (CBMN) in peripheral blood lymphocytes, (PBLs) was used as a biomarker for chromosome damage. A total of 244 participants, including 171 workers occupationally exposed to TCE and 73 non-exposed control employees, working mainly in office jobs in the same factory, were enrolled in this study. Analyses of airborne TCE concentrations in the workplace, and of urinary trichloroacetic acid (TCA) of the workers and controls, were performed by Gas Chromatography-Electron Capture Detector (GC-ECD) using the modified headspace technique. The average concentration of TCE in the workplace breathing zone was 27.83 ± 6.02 ppm. The average level of urinary TCA of the exposed workers and controls was 14.84 ± 1.62, 2.95 ± 0.28 mg/L. The frequency of MN/1000BN was 7.029 ± 0.39, significantly higher than for those in the control group (3.57 ± 0.31, p = 0.001). According to multiple linear regression analysis, the results indicated that urinary TCA levels correlated with the increased MN in exposed workers (r = 0.285, p < 0.001). The prevalence rate of subjective symptoms in the exposed group was 9.61-11.76 times higher than the rate of the non-exposed group (p < 0.001). It was found that skin (29.6%) and respiratory symptoms (21.1%) were the most frequent among the exposed workers. In conclusion, these results indicate that increased micronucleus frequency is associated with occupational trichloroethylene exposure. The use of TCE in the factory is threatening workers' health.