Given the occupational risks of hazardous waste workers, this study was conducted to explore possible differences in medical surveillance practices among blue and white collar workers. Demographic and medical surveillance data were collected from 636 white collar and 206 blue collar trainees, enrolled in health and safety training courses. Overall, 4.5% of the trainees reported being ill or injured because of hazardous substances. Significant differences (P < .0001) were noted between groups; blue collar trainees were more likely to have been ill or injured. Differences also existed for medical surveillance enrollment; 32% of the white collar trainees report enrollment compared to 19% of the blue collar trainees (P = .004). This study indicates that blue collar trainees are more likely to be injured and less likely to be enrolled in medical surveillance programs. Issues of illness and injury, as well as medical surveillance enrollment, must be addressed; ensuring that all workers receive medical surveillance needed to prevent occupational illness in the hazardous waste field.