IntroductionDespite the critical role of bus drivers in the Ghanaian economy, research on their safety is limited, hindering progress towards reducing road traffic crashes (RTCs) in line with Sustainable Development Goal (SDG) 3.6. This study aimed to investigate the rate of RTCs and near misses among long-distance bus drivers, identifying key predictors.MethodThis cross-sectionl survey sampled 7,315 long-distance bus drivers operating from Accra and Tema to other parts of Ghana and sub-region. Descriptive and binary logistic regression analyses were condcuted using Jamovi software version 2.5.3.ResultsThe study found that 53.7% and 96.9% of bus drivers had at least one RTC and one near-miss two years prior to data collection respectively. Older age, higher education, and extensive driving experience (≥ 21 years) reduced RTC risk, while factors like 6–20 years of experience, individual bus ownership, irregular shifts, long driving hours, sleepiness, job security, low decision authority, and skill discretion increased RTC risk. Near-misses were more likely with public bus ownership, not driving alone, low decision authority, skill discretion, and supervisor support, while high work-family conflict reduced near-miss likelihood.ConclusionConcerted efforts are needed to implement targeted interventions aimed at regulating working hours, enhancing job security and integrating occupationl health and safety standards in the Ghanaian bus transport industry. By prioritizing evidence-based policies and practices, stakeholders can work towards creating safer roads and healthier work environments for bus drivers.