As the workforce ages, the incidence of occupational falls is increasing. However, risk factors for occupational falls in farm workers have not been evaluated in detail. The current study sought to identify the risk factors for occupational falls among middle-aged and elderly farm workers in Thailand. We conducted a cross-sectional study using a self-administered questionnaire among 419 farm workers aged ≥40 years in Nan province, Thailand. Multiple logistic regression analysis was used to examine the factors associated with occupational falls. Occupational falls were experienced by 25.5% of participants. Men had 2.22 times higher odds of occupational falls than women (95% confidence interval [CI]: 1.19-4.13). Participants aged ≥60 years were less likely to experience occupational falls compared with those aged 40-49 years (odds ratio [OR]: 0.44; 95% CI: 0.20-0.96). Fruit growers were 2.72 times more likely to experience occupational falls than rice growers (95% CI: 1.33-5.55). Individuals with body mass index ≥30 kg/m2 and over were 3.05 times more likely to experience occupational falls than those with body mass index <25 kg/m2 (95% CI: 1.11-8.40). The sex- and age-related trends in fall risk may indicate that elderly individuals and women in agriculture tend to be assigned lighter duties through work accommodation. To prevent falls during agricultural work, it is necessary to pay attention to farm-specific tasks and work environments, such as working at a height in fruit cultivation, as well as instability of walking caused by obesity.