South Africa has one of the highest burdens of tuberculosis globally. Transmission of tuberculosis in healthcare settings is common and healthcare workers face an increasing threat of becoming infected. The aim of this study was to calculate the incidence of tuberculosis reported among healthcare workers in public sector hospitals and clinics within eThekwini Health District in KwaZulu-Natal, South Africa, from 2006 to 2010. A retrospective review of tuberculosis registers at occupational health clinics was conducted in 11 hospitals and four community health centres in the District. All healthcare workers who were diagnosed and treated for tuberculosis at these facilities were included in the study. Six hundred and eighteen healthcare workers were diagnosed with tuberculosis during the study period; a total of 67 562 healthcare workers were employed. The mean incidence of tuberculosis over the study period was 908 cases per 100 000 (95% CI 771 - 1 046). The incidence of tuberculosis in healthcare workers was higher than that in the general population but lower than in the provincial and district populations. Tuberculosis among healthcare workers remains an important occupational health issue. The high burden of tuberculosis in KwaZulu-Natal, and under-reporting of tuberculosis among healthcare workers are likely to have masked the high incidence among healthcare workers.