Since 70% of the labor force of Pakistan is the part of informal economy, poverty alleviation is conditional with improvement in quality and quantity of available work. Pakistan has entered into an agreement with International Labor Organization (ILO) through "Decent Work Country Program” which bounds it to implement on Decent Work Agenda. Current study investigates the status and trends of decent work issues in 17 cotton ginning small and medium enterprises (SMEs) in three districts of Pakistan. There was some evidence of child labor however; children were not engaged in hazardous work. Most of the employments (90%) were seasonal (for three months), characterized by insecure and inadequate working conditions. There was a gender based discrimination in daily wages i.e. Rs. 328±12 for male workers while Rs.187±9 for female workers. Average daily working hours (11.79±0.166) were higher than that of set by Factories Act, 1934 of Pakistan (maximum 10 hours a day for seasonal employment). Seven kinds of hazards were identified at work place i.e. dust, noise, cold and heat stress, slips and trips and bad light and chemicals. These conditions led to nine health related issues including whistling ears (23%), frequent cough (20%), frequent fever (15%), cut and bruises (12%) and backache (12%), headache (10%), sleepy at work (4.5%), poor eyesight (4%) and eye injuries (0.5%). Owners provided workers with few facilities i.e. residence (70%), meal (16%) and advance salary (8%). Importantly, fifty five percent of the respondents were not satisfied with their work and income. Current survey will serve as a baseline and can support in streamlining decent work programs in cotton ginning SMEs of Pakistan.