The waste management sector is dominated by micro and small-sized enterprises. Although it is possible to anticipate that they may face the same problems as other small firms, information about activities related to the prevention of occupational risks in this sector and how this influences Occupational Health & Safety (OHS) performance is still limited. This study aims to address the issue, contributing to current literature about the protection of employees and the prevention of occupational risks in the waste management sector. The study was conducted at 66 enterprises in Portugal. Data about OHS management practices was collected through different sources, such as questionnaires applied to employers and analysis of documents and records available at the enterprise. A summative index that assesses seven OHS performance aspects was used to characterize the enterprises regarding their OHS performance level. The results showed that micro and small-sized waste management firms display several constraints with regard to OHS management. Several enterprises still do not have organized preventive services. Additionally, OSH policies or objectives, risk assessment, training and accident recording mechanisms were found to be non-existent in several cases. The time dedicated by employers to OHS issues and the support of external advisory services was also low for some firms. A positive and statistically significant association was found between these variables and the enterprises’ OHS performance level. Future research will focus on designing an intervention to improve OHS in the waste management sector as a whole.