Globalization and the changing nature of work have brought many new health and safety challenges to the workplace, especially for developing countries. More than three-quarters of the world’s total working population still do not have access to OHS services in 2014, and the coverage rate of basic OHS services is often lowest in low- and middle-income countries. These low OHS services, combined with the OHS hazards and psychological risks, put workers in low and middle-income countries at high risk from the health problems at the workplace. This is particularly the case for migrant workers who often face the double burden of health and safety issues from both their workplaces and their social circumstances. However, few studies examine this health and safety double burden that internal migrant workers experience. None of the current literature provides insight into how this double burden may affect internal migrants in low and middle-income countries such as Vietnam. In the past few decades, the rapid increase of industrial activity has drawn a great number of people from rural areas to work in urban industrial sectors in Vietnam. This puts significant pressure on Vietnam’s workplace health system. In 2014, fewer than 20% of workers in Vietnam’s formal sectors were covered by OHS services. Since then, a growing number of internal migrants has entered the manufacturing sector, putting even more pressure on Vietnam’s health system. Therefore, it is critical and urgent to ascertain internal migrant workers’ health and safety needs so that adequate healthcare provisions can be developed. To this end, this study adopts the ‘integrative workplace health promotion’ (IWHP) approach to guide its research. Using Vietnam’s garment industry as a setting, this research aims to investigate the health and safety issues experienced by internal migrant workers and suggest potential strategies to promote their health. The study uses a combination of qualitative and quantitative methods, guided by the comprehensive Community Needs Assessment (CNA) framework developed by Chu. The study first compiled the workplace community profile through secondary data analysis. It then investigated the issues and solutions defined by experts and authorities by interviewing 17 policymakers, trade union representatives, OHS experts and workplace managers. Workers’ views and experience (felt needs) were collected through participant observation and in-depth interviews of 21 migrant workers. Finally, a questionnaire survey was administered to 328 internal migrant workers in the garment industry to identify the expressed needs and to verify the felt needs. The study’s findings confirm that migrant workers in Vietnam’s garment industry face a double burden from both OHS issues and their social circumstances. These workplace and social issues are often interrelated and work in combination to influence migrants’ health and wellbeing. The work-related issues adversely impacting on garment workers’ health and safety related to their working conditions, management culture, job pressure, and weak OHS protections. Apart from observable hygiene hazards such as dust, noise, and poor ergonomics, workers reported experiencing pressures from long working hours, high speed and volume demands from their job (52.5%), and a low level of job control (42%). Furthermore, 16.8% of migrant workers reported that they experienced verbal abuse and bullying from their supervisors, which has affected them emotionally, mentally and even physically. Furthermore, the combination of the lack of OHS services, weak collective bargaining power, poor health and safety culture at the workplace and a lack of reporting mechanisms left migrant workers unprotected against health and safety issues arising in the workplace. The living conditions that influence migrant’s health significantly include low-quality housing, poor sanitation conditions, and unsafe living environments. Nearly 50% of the worker had to share the toilet and wash facilities with other households. Migrants also experienced sadness, loneliness and stress from being separated from their family and children, and social isolation. Among migrants who had a child/children, 47.2% lived apart from their children. In addition, 7.3% of migrant workers reported being socially isolated and 11% reported experiencing a low level of social support. Structural or policy factors, the Ho Khau policy (household registration system) in particular, remain the key barrier to internal migrants’ access to healthcare and social services. Based on the CNA findings, the study recommends practical measures to address worker needs in accordance with the five action strategies of the Ottawa Charter for Health Promotion. The key recommendations are: removing the restriction to health and social services associated with Ho Khau status; developing affordable housing for migrant workers; strengthening the roles of independent trade unions and worker representatives to negotiate on behalf of workers concerning health and safety issues; setting clearly defined guidelines regarding abuse, harassment and bullying prevention and control as a corporate social responsibility; and strengthening workplace health and safety culture including the provision of pathways for employee input and concerns in a timely manner. In conclusion, the study demonstrates the utility of the comprehensive CNA framework to support the IWHP approach to design tailored, effective strategies to address internal migrant health needs. The findings of this study should also inform other industrializing low- and middle-income countries sharing similar challenges relevant policies and strategies to address the health and safety concerns of their migrant worker populations.