It has been observed that the average life expectancy of a sewer worker in India is less than 50 years. Occupational Health and Safety (OHS) is an all-inclusive approach for reducing the risk of hazards a sanitation worker is exposed to. It is inferred that PPE is the last line of defense and is rendered ineffective without applying higher order of control measures. To address the issue holistically, this document presents the recommendations and way forward for “Mainstreaming Occupational Health and Safety in FSSM sector”. The recommendations are specific to key stakeholders involved in policy and regulation making at national level and its enforcement at state level.