Background <p>In the context of the changing need for health care and prevention due to climate, digital and demographic change, occupational health services are of enormous relevance, as many people can be reached. Of particular interest are the occupational health services in micro-, small- and medium-sized enterprises (MSMEs), as smaller companies are experiencing an unequal distribution of resources. To optimise the implementation in MSMEs, the aim of this scoping review is to present an overview of the MSMEs’ needs regarding occupational health services.</p> Methods <p>The literature search was conducted through Embase, Pub Med, Scopus, and Web of Science. Additionally, a manual search was performed through the references of included sources. A protocol was registered with Open Science Framework. The screening was conducted by two reviewers. Eligible were peer-reviewed articles in English and German, published between 2000 and 2024 on the perspective of MSMEs regarding occupational health services. The articles were narratively synthetised. A critical appraisal was carried out.</p> Results <p>A total of 1,252 sources were found during the search on August 26, 2024. Fifteen were included from the database search and two from the manual search. The studies used qualitative (<i>n</i> = 11), quantitative (<i>n</i> = 3) or mixed-methods (<i>n</i> = 3) approaches. The narrative synthesis identified five categories of felt and expressed needs with fourteen subcategories. MSMEs had a need for <i>collaborative culture</i> including communication, participation, trusting relationships and external support. The need for <i>knowledge and competencies</i> contained information, training and accessibility. <i>Organizational structures</i> subsumed the need for time, financial, technical resources as well as management commitment and simple solutions. Tailored legislation and less bureaucracy were categorised as needs for <i>political and regulatory context</i>. In the included studies, <i>a selection of specific interventions</i> such as flu vaccination, ergonomic solutions and psychosocial risk assessment were discussed.</p> Conclusions <p>To optimise the implementation of occupational health services, this overview shows that political stakeholders and occupational health professionals should improve the organizational structures, political and regulatory context, collaborative culture with and the knowledge and competencies of MSMEs. Further research is recommended with the explicit aim of identifying the needs of MSMEs in each sector on occupational health services, psychosocial risk and assessments.</p>