Purpose: Millions of workers exposed to the outdoor environment are extremely susceptible to extreme heat. Although several articles analyzed heat-related illnesses, injuries, fatalities at the country level, few investigated regional and state statistics especially for OSHA Region 4 and the state of Alabama, U.S, which we explored in this study. Methods: We studied the number of heat-days over 90 °F (32.2 °C) heat-index within our study area, analyzed heat-related injury and illnesses to calculate their incidence rate during 2015 to 2019, observed the nature of such incidents, their monthly occurrence, and incidence trend over average air temperature. We conducted a comparative analysis of heat-related fatalities between construction and all industries. The existing heat regulations by OSHA and some state agencies have also been summarized. Results: We observed the highest mean, maximum heat-days and injury-illness rate in the south and southeast part of Region 4; increase in incidence rate from 0.03 in 2017 to 0.28 per 10,000 employees in 2018 for the contiguous U.S; highest injury-illness rate (HIR) in OSHA Region 1, 4 and 6; highest HIR in Lee, Montgomery, Mobile and Madison counties of Alabama; 34.7% (construction) and 31.3% (all industries) of all cases experiencing nonclassifiable heat-light effects; high fatalities in construction industry with a trend of 1 death/5 years; increased mortality in all occupations with 1 death/2.4 years. We also proposed a Heat-Stress Index (HSI) as a routine heat-stress measure on jobsite. Conclusion: The findings from this research and the proposed index can help in understanding heat-related risk at a regional level and implementing workplace interventions.