Abstract Background: The high prevalence of smoking on the mines contributes significantly to the public health burden due to exposure to crystalline silica dust and high HIV and TB prevalence rates. Progressive anti-tobacco legislation that informs workplace smoking policies is in existence but there are no formal smoking interventions to achieve the objectives of such policies and to facilitate health promotion. Health care workers, in particular have a vital role to play in this regard. Objectives: The objectives of this research study were to determine the knowledge, attitudes and practices of HCWs regarding prevention of smoking in gold mine workers and to use this information to propose a framework for a smoking intervention programme for the mines. Methods: This was a cross-sectional descriptive knowledge, attitudes and practice (KAP) study. Data were obtained from 69 HCWs using self-administered questionnaires, from 161 occupational lung disease (OLD) and 30 medical ward admission record reviews, and from 4 informal discussions. Results: While knowledge and attitudes about smoking was good overall and 84.1% of HCWs reported that they would routinely ask smoking status and document it, this was not done in practice. An overwhelming majority of HCWs are aware that smoking is harmful to one’s health (98.6%); is harmful to mine workers’ health (97.1%), and predisposes them to acquiring lung diseases (95.7%). Half (56.7%) of the nurses, but no doctors documented smoking history on admission and poor follow up of this advice (38.5%) is an area of concern. HCWs identified a need for support structures such as workplace and community programmes that include education, training and awareness campaigns. Conclusion: Overall, HCWS are responsive to workplace smoking interventions: they are knowledgeable, and show insight and have positive attitudes towards smoking interventions, but a more enabling environment is required to establish good workplace practices. To this end a “Proposed framework for smoking interventions on the mines, incorporating the HCW programme” has been developed and partially implemented. Awareness of this study and its preliminary findings has already demonstrated a paradigm shift in thinking about tobacco on the gold mines.