This questionnaire study evaluates how work ability and musculoskeletal symptoms associate with physical work factors and individual characteristics of the workers in cooled food-processing facilities. A total of 1,117 workers (response rate 85%) responded to the study. Poor work ability was significantly associated with longer work duration, experience of draught at the workplace, absence from work due to health reasons, and physical inactivity during free time. The amount of local cooling experienced was significantly associated with the risk for musculoskeletal symptoms in the neck-shoulder region, shoulders, wrists and lower back. Additionally, female gender, longer work duration and poor work ability were associated with the increased prevalence of the symptoms. The prevalence of musculoskeletal symptoms was significantly higher among older employees (40 to 64 yr) than among younger employees (18 to 39 yr) for all regions except wrists. Cold discomfort and unpleasant sensations due to the physical factors of work were significantly more common among females than males. The results showed that, in addition to individual characteristics of workers, factors related to work in a cool environment (experience of draught and cooling and long exposure to cold) are associated with poor work ability and musculoskeletal symptoms.