Literature shows that cervical cancer is very prevalent among women living in low resource settings. Once it progresses to invasive cervical cancer, its cost is very high. Thus, screening cervical cancer is highly recommended in poor settings including Ethiopia, where the disease burden is very high. However, little is documented on the prevalence and determinants of precancerous cervical lesion among healthy women. Thus, this study aimed to assess the prevalence and factors associated with precancerous cervical lesion among women working in Almeda textile factory, Adwa, North Ethiopia. An institution-based cross-sectional study was conducted from February 20 to 25, 2016 among women working in Almeda textile factory in North Ethiopia. Three hundred forty-two women were included in this study. Data were collected using a structured checklist. SPSS version 20 was used for data entry and analysis. Logistic regression was used to identify factors associated with the precancerous cervical lesion. Statistical significance was set at p-value < 0.05. The mean (± SD) age of the respondents included in this study was 32.95 (± 6.94). In this study, the overall prevalence of precancerous cervical lesion was 6.7% (95% CI: 4.4, 9.6). Being infected with sexually transmitted infections [AOR=49.88, 95% CI: (16.59, 149.91)] was significantly associated with the precancerous cervical lesion. In conclusion, the prevalence of precancerous cervical lesion was high among women working in Almeda textile factory in North Ethiopia. Therefore, cervical cancer screening and treatment services should be initiated and expanded to reduce morbidity from cervical cancer and its adverse effects.