This review examines the challenges associated with occupational disease surveillance in Korea, particularly emphasizing the limitations of current data sources such as the Industrial Accident Compensation Insurance (IACI) statistics and special health examinations. The IACI system undercounts cases due to its emphasis on severe diseases and restrictions on approvals. Special health examinations, although they cover a broad workforce, are constrained by their annual scheduling, which leads to missed acute illnesses and subclinical conditions. The paper also explores the history of occupational disease surveillance in Korea, highlighting the fragmented and disease-specific approach of earlier systems. The authors introduce the newly established Korea Occupational Disease Surveillance Center (KODSC), a comprehensive nationwide system designed to gather, analyze, and interpret data on occupational diseases through a network of regional centers. By incorporating hospital-based surveillance and focusing on acute poisonings and other sentinel events, the KODSC aims to overcome the limitations of previous systems and promote collaboration with various agencies. Although it is still in the early stages of implementation, the KODSC demonstrates potential for improving data accuracy and contributing valuable insights for public health policy.

Background/Objectives: Small-scale workplaces often have limited access to occupational health services, despite potential exposure to hazardous solvents. Biological monitoring can provide worker-level evidence of internal exposure when routine environmental monitoring is limited. This study evaluated urinary biomarkers of benzene and toluene exposure among workers in small-scale printing workplaces in South Korea and examined whether self-reported chemical handling corresponded with biomarker patterns. Methods: In this cross-sectional field biomonitoring study, 21 workers from eight printing companies provided end-of-shift urine samples. Creatinine-adjusted urinary concentrations of trans,trans-muconic acid (t,t-MA), S-phenylmercapturic acid (SPMA), phenol, and o-cresol were analyzed and compared with applicable biological reference values. Associations between reported chemical handling and elevated biomarker levels were estimated using Firth’s penalized logistic regression, and correlations among log-transformed biomarkers were explored. Results: Nine workers (42.9%) had urinary o-cresol concentrations at or above the American Conference of Governmental Industrial Hygienists (ACGIH) biological exposure index of 300 μg/g creatinine. Workers reporting benzol handling, a local term for petroleum-based cleaning products, had higher odds of elevated SPMA, although the estimate was imprecise and hypothesis-generating (age-adjusted OR 6.04, 95% CI 0.75–104.90, p = 0.093). The correlation between SPMA and t,t-MA was stronger among workers reporting benzol handling (r = 0.94) than among those reporting toluene handling (r = −0.01). Conclusions: These exploratory findings indicate that toluene-related internal exposure is a relevant occupational health concern in small-scale printing workplaces, while reported benzol handling may indicate possible low-level benzene-related exposure. Urinary biomonitoring may support exposure surveillance and preventive occupational healthcare in small enterprises when interpreted alongside workplace observations, product information, ventilation, protective equipment use, and worker education.