Occupational exposure to aluminium, arsenic, lead, cadmium, and manganese can increase the risk of numerous neurophysiological changes in workers, and may lead to conditions resembling Parkinson's and Alzheimer's disease. However, although the health hazard aspect of these agents has been examined, biomass-fired power plant workers' exposure to them remains a neglected issue. The purpose of this study was to measure maintenance and ash removal workers' multiple exposures to inhalable dust, metals, and crystalline silica during their work tasks in biomass-fired power plants. Maintenance and ash removal workers were exposed to high inhalable dust concentrations inside biomass-fired boilers. The median air inhalable dust concentration in workers' breathing zones were 33 mg m(-3) and 120 mg m(-3) in ash removal and maintenance tasks, respectively. The median concentration of manganese (0.31 mg m(-3)) exceeded the occupational exposure limit in worker's breathing zone samples in maintenance tasks. The most evident exposure-associated health risk from multiple exposures to metals was that of cancer, followed by central nervous system disorders, lower respiratory tract irritation, and finally upper respiratory tract irritation. To avoid the above mentioned health effects, powered air respirators with ABEK+P3 cartridges and carbon monoxide gas detectors are recommended as the minimum requirement for these work tasks. A compressed air breathing apparatus is the best form of protection for the most demanding work phases inside boilers in biomass-fired power plants.