A study of occupational exposure to paraquat was performed among 11 knapsack spray operators at banana plantations in Costa Rica. External and internal exposures were quantified and determinants of exposure identified by measurements, observations, and interviews. Dermal exposure was measured with skin pads, respiratory exposure by personal air sampling, and internal exposure by urine sampling. The wrists, back, and legs were the areas with the highest levels of dermal exposure. Respiratory exposures appeared to be strongly influenced by differences between days, while dermal exposures varied mostly due to differences between plantations. The use of protective clothing did not effectively protect against dermal exposures. Both respiratory and dermal exposures were significantly related to internal exposures, and both should be considered possible routes for systemic absorption of paraquat. It cannot be excluded that measurable levels of exposure can lead to acute as well as chronic health effects. Furthermore, due to poor conditions within the working environment, the spray operators are continuously at risk for high exposures that could lead to severe intoxication, and therefore a strategy for control of exposure is necessary.