Background: Heat stress is common among workers in arid and semi-arid areas. In order to take every preventive measure to protect exposed workers against heat-related disorders, it is crucial to choose an appropriate index that accurately relates environmental parameters to physiological responses. Objective: To investigate the consistency between 2 heat stress and strain indices, ie, sweat rate and wet bulb globe temperature (WBGT), for the assessment of heat stress of people working outdoor in arid and semi-arid regions in Iran. Methods: During spring and summer, 136 randomly selected outdoor workers were enrolled in this study. Using a defined protocol, the sweat rate of these workers was measured 3 times a day. Simultaneously, the environmental parameters including WBGT index were recorded for each working station. Results: The level of agreement between sweat rate and WBGT was poor (kappa<0.2). Based on sweat rate, no case exceeding the reference value was observed during the study. WBGT overestimated the heat stress in outdoor workers compared to sweat rate. Conclusion: It seems that the sweat rate standards may need some modifications related to real condition of work in arid and semi-arid regions in Iran. Moreover, it seems that judging workers solely based on monitoring their sweat rate in such regions, can probably result in underestimation of heat stress.