This study examines the relationship between safety climate, safety culture, and occupational health outcomes among workers in the Chilean education sector. Although psychosocial risks in schools have received growing attention, the links between preventive culture and health symptoms remain underexplored. A mixed-methods design was implemented in 16 educational institutions. A safety climate questionnaire was completed by 363 participants (278 women and 85 men), and 34 semi-structured interviews were conducted with school personnel and occupational health professionals. Quantitative analyses showed that lower safety climate scores were significantly associated with a higher prevalence of self-reported musculoskeletal pain and psychological distress. These associations were more pronounced among women, reflecting the gendered dynamics of the sector. Qualitative findings indicated a predominantly reactive prevention culture, in which risks are often normalized or overlooked, particularly in relation to emotional demands, organizational tensions, and work overload. Gender emerged as a structuring factor in how risks are perceived and managed, influencing access to support, recognition, and protective measures. The study concludes that occupational health strategies in education require a more integrated approach that combines ergonomic and psychosocial perspectives and incorporates a gender lens. Such an approach can help address structural inequalities in exposure to risk and foster a more inclusive and effective safety culture in schools. These findings contribute to a broader understanding of occupational health in service sectors and highlight the value of mixed methods for capturing the complex configurations of safety and health in feminized workplaces.