India, a growing economy and world's largest democracy, has population exceeding 1.2 billion. Out of this huge number, 63.6% form working age group. More than 90% work in the informal economy, mainly agriculture and services. Less than 10% work in the organized sector; mainly industry, mining and some services. New service industries like Information Technology (IT), Business Process Outsourcing (BPO) are increasing rapidly; so is the proportion of females in the workforce. The occupational safety and health (OSH) scenario in India is complex. Unprecedented growth and progress go hand in hand with challenges such as huge workforce in unorganized sector, availability of cheap labor, meager public spending on health, inadequate implementation of existing legislation, lack of reliable OSH data, shortage of OSH professionals, multiplicity of statutory controls, apathy of stakeholders and infrastructure problems. The national policy on OSH at workplace, adopted by the government in 2009, is yet to be implemented. Some of the major occupational risks are accidents, pneumoconiosis, musculoskeletal injuries, chronic obstructive lung diseases; pesticide poisoning and noise induced hearing loss. The three most important OSH needs are: 1. legislation to extend OSH coverage to all sectors of working life including the unorganized sector; 2. spreading the awareness about OSH among stakeholders; 3. development of OSH infrastructure and OSH professionals. Other issues include integration of occupational health with primary health care.