Prevalence of neck-shoulder pain among sewing machine operators is well known. It may be due to the nature and incorrect posture used by sewing machine operators while performing sewing work. However, up till now there is no empirical evidence that can be used to relate the risk factors that would results towards the development of neck and shoulder pain among sewing machine operators. The main objective of this study is to identify and investigate the risk factors that result in neck and shoulder pain among Malaysian sewing machine operators. Twenty female sewing machine operators took part in answering a survey questionnaire to investigate the prevalence of neck and shoulder pain among sewing machine operators. The survey questionnaire was divided into five sections: socio-demographic, work background, workload information, physical exposures and physical musculoskeletal symptoms experienced by workers. Having done that, sewing machine operators who have been screened with neck and/or shoulder pain was evaluated with Rapid Upper Limb Assessment (RULA) to determine the level of workplace risk factors. Subjects without neck and/or shoulder pain were excluded. Results of the study shows that all sewing operators were expose to risk of prolonged sitting, repetitive task and working at high speed. Ninety five percent of sewing machine operators had experienced neck and/or shoulder pain and 80% of them were exposed to high work risk factors that require them to undergo further investigation. Shoulder pain was found to be strongly correlated with high work risk factor among sewing machine operators (p