As important place for water storage and supply, drinking-water reservoirs in karst mountain areas play a key role in ensuring human well-being, and its water quality safety has attracted much attention. Source apportionment and ecological risks of heavy metal(loid)s in sediments of drinking-water reservoir are important for water security, public health, and regional water resources management, especially in karst mountain areas where water resources are scarce. To expound the accumulation, potential ecological risks, and sources of heavy metal(loid)s in a drinking-water reservoir in Northwest Guizhou, China, the surface sediments were collected and analyzed based on the combined use of the geo-accumulation index (I), sequential extraction (BCR), ratios of secondary phase and primary phase (RSP), risk assessment code (RAC), modified potential ecological risk index (MRI), as well as the positive matrix factorization methods. The results indicated that the accumulation of Cd in sediments was obvious, with approximately 61.9% of the samples showing moderate to high accumulation levels, followed by Pb, Cu, Ni, and Zn, whereas the As and Cr were at low levels. A large proportion of BCR-extracted acid extractable and reducible fraction were found in Cd (72.5%) and Pb (40.3%), suggesting high bioavailability. The combined results of RSP, RAC, and MRI showed that Cd was the major pollutant in sediments with high potential ecological risk, while the risk of other elements was low. Source apportionment results of heavy metal(loid)s indicated that Cd (75.76%) and Zn (23.1%) mainly originated from agricultural activities; As (69.82%), Cr (50.05%), Cu (33.47%), and Ni (31.87%) were associated with domestic sources related to residents' lives; Cu (52.36%), Ni (44.57%), Cr (34.33%), As (26.51%), Pb (24.77%), and Zn (23.80%) primarily came from natural geological sources; and Pb (47.56%), Zn (22.46%) and Cr (13.92%) might be introduced by mixed sources of traffic and domestic. The contribution ratios of the four sources were 18.41%, 36.67%, 29.48%, and 15.44%, respectively. Overall, priority control factors for pollution in relation to agricultural sources included Cd, while domestic sources are primarily associated with As. It is crucial to place special emphasis on the impacts of human activities when formulating pollution prevention and control measures. The results of this study can provide valuable reference and insights for water resources management and pollution prevention and control strategies in karst mountainous areas.