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Heavy physical workload for long hours coupled with increasing workplace heat exposure due to rising temperatures stemming from climate change, especially where there are inadequate prevention and control policies, adversely affect workers health and safety, productive capacity and social well-being. However, variations in workers' concerns and awareness of occupational heat stress and climate change risks impede the effectiveness of heat stress management. A mixed method approach was used to assess climate change perceptions and occupational heat stress risks and adaptation strategies of Ghanaian mining workers. Questionnaires and focus group discussions were used to collect data from 320 respondents. Quantitative and qualitative approaches were used for data analysis. Workers' climate change risk perception, as confirmed by trends in climate data, was reasonable, but concerns about climate change effects and workplace heat exposure risks varied significantly across types of mining activity (p < 0.001). Workers experienced heat-related morbidities, but the variation in heat-related morbidity experiences across the type of mining activity was not significant. However, the type of heat-related morbidities experienced by workers differed across the type of mining activity (p < 0.001). Workers' awareness of occupational heat stress prevention and control was adequate. The disparities in workers awareness and use of the prevention and control measures significantly differed across the type of mining activity (p < 0.001). Occupational heat stress prevention activities should focus on workers, and a concerted effort must be made to promote workers adaptive capacity and inform policy decisions. (C) 2018 Elsevier B.V. All rights reserved.