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Background Global warming is accelerating. One degree C warming across Australia has generated a six-fold increase in heat extremes, as days above 35oC (and upwards of 45oC) are increasingly common. Many industries require staff to engage in outdoor work, often involving high levels of physical intensity. Compliance with occupational heat guidelines is reportedly low. Adoption of health protective strategies requires accurate risk perception. Australian heat exposed workers report discomfort when working in hot weather, yet little is known about their personal risk assessment. Methods Heat exposed outdoor workers across Australia (n = 112) completed pre-study surveys about their personal heat tolerance and completed daily heat diaries (n = 3421) to record their thermal comfort, heat symptoms and productivity, whilst on-site maximum temperatures and humidity were monitored. Results Daily maximum temperatures ranged from 18-43oC, and WBGT levels in parts of Australia exceed hazardous levels most days throughout summer. Significant overestimation of thermal tolerance was reported, as “feeling too hot to keep working” and emergence of symptoms occurred up to ten degrees lower than expected. Conclusions Heat exposed workers consistently over-estimate their thermotolerance and capacity to perform physically intensive work. Increasing frequency and intensity of heat waves escalates future risks of health harm and deaths among heat exposed workers. Health protection necessitates active health education/ health promotion campaigns to better align perceived and actual health risks. Main messages: Global warming presents intensifying health and productivity threats. Widespread lack of recognition of personal health threats suggests a critical need for heath education/promotion to increase heat guideline compliance Key messages Increasing frequency and intensity of heat waves from climate change escalates future risks of health harm and deaths among heat exposed workers who over-estimate their thermotolerance. Widespread lack of recognition of personal heat exposure threats suggests a critical need for health education/promotion to increase heat guidelines compliance.

Overestimation of heat tolerance calls for health promotion to limit occupational heat risk