Aim: Since 1st October 1999, car repair shops have been obliged to provide occupational health care for their employees. The purpose of this study was to find out whether and to what extent this requirement is fulfilled. Method: From 2000 until the beginning of 2002 we examined 378 of 2886 car repair shops in Lower Saxony using a standardised procedure. Results: The majority of the repair shops had between 1 and 20 employees. At the time of the survey 20 percent were still without occupational health care. In about 50 percent of the remaining garages we could not trace any significant effect of the attendance of an occupational physician. Most of the occupational health care providers were active also outside Lower Saxony. About 37 percent of the occupational physicians were still trainees in occupational medicine. In most cases the contract between the employer and occupational physician lacked detailed information about the tasks and required time. Conclusions: Our study found considerable shortcomings in the occupational health care of small car repair shops. We assume that the results would be similar in other small enterprises. Thus, cooperation between employers, employees, the industrial safety authorities and occupational physicians is needed in order to elaborate effective and practical concepts for the occupational health care of small enterprises.