We sought to explore the possibility that exposure to noise at work might interact with job complexity and gender to affect the incidence of occupational injury among industrial employees. In this study, we examined 4084 men and 1643 women from 21 industrial plants while controlling for a number of potent confounding variables, among them active safety hazards. Logistic regression results showed that the predictor variables interacted and that the highest injury risk (odds ratio = 2.72) was observed in women in high noise and high job complexity, compared with the referents scoring low on these predictors. The comparable injury risk in men was only 1.3. Parallel results were observed for three noise stress indicators: workload, noise annoyance and postwork irritability. We conclude that the joint exposure to noise and high job complexity is disruptive, resulting in higher distress and occupational injury risk, particularly among women.