Very few reports have been published on organizational climate, health, and sickness absence in a representative sample of the entire workforce. The aim of this study was to determine how the perceived organizational climate of a workplace is related with work-related symptoms and sickness absence and how these factors vary according to sociodemographic and work-related characteristics. Data were collected in computer-assisted telephone interviews of a random sample of 4209 currently employed Finns drawn from the population register. A tense and prejudiced climate was associated with a higher risk of work-related symptoms than a relaxed and supportive climate (odds ratio [OR] 3.0 (95% CI = 2.4-3.7). The corresponding ORs were 4.3 (95% CI = 3.3-5.6) for psychological symptoms, 1.6 (95% CI = 1.2-2.0) for musculoskeletal symptoms, and 1.6 (95% CI = 1.3-2.1) for more than the average number of sick-leave days. Part of the impact of organizational climate on sickness absence is not caused by an increase in work-related symptoms. Thus, organizational climate seems not only to correspond with organizational practices and leadership but also occupational health. Organizational climate could be used as a research tool in attempts to reduce work-related ill health and sickness absenteeism.