Trace metallic elements (TMEs) are pollutants of great concern even in trace amounts because of their toxicity and cumulative property. Some of them can be carcinogenic. The Sfax metropolis, located in the southern region of Tunisia, has been affected by releases of TMEs for decades. Several studies confirmed that this pollution is predominantly originated from anthropogenic sources, mainly from industrial activities. It represents a threat to the health of residents, particularly for those also exposed during occupational activities in industrial processes. The present study aims to assess health risks associated with occupational exposure in industries handling TMEs in their production processes, following the human health risk assessment approach. To this end, five companies using raw material containing TMEs to produce a variety of metallic products accepted to participate to the study. The metals that were investigated are Al, Cr, Ni, Cu, Zn and Pb. Mathematical models for estimating occupational exposure to chemicals were used to predict indoor air TME exposure levels in 15 different job tasks. Air monitoring was conducted in order to compare the predicted workplace air concentrations versus the direct measured ones, using both workplace-fixed monitors and personal samplers. And finally, urine samples were collected from 61 workers to assess whether TMEs excretion correlate with job exposure levels. Globally, the predicted air estimates relate well with measured concentrations over the whole set of job tasks. Better predictions were found for certain activities, in particular for steel cutting and welding processes. The values that correspond to the 90th percentile of the exposure distribution were then used in the interaction-based hazard index HIint to assess health risks associated with the mixtures of TMEs. Total cancer risk was also investigated. Results showed high exposures for metals that may elicit respiratory conditions, with a HIint reaching 93.6, the highest levels being for the shielded metal arc welding and metal shearing and slitting tasks. The risk is enhanced by a synergetic effect between Cr, Ni and Cu. High risks of lung and kidney cancers were demonstrated (the predicted life-long total cancer risk for exposed workers is 3.7×10-4). This work shows that mathematical models can be accurate in predicting TME airborne exposure levels for several processes in the metallurgic industry, a result that is of interest to help the different stakeholders to monitor efficiently exposure surveillance and abatement. Progress in industrial hygiene is needed in this industrial sector to reduce the high level of health risks currently experienced by the metalworking workers.