<p>Cooking with biomass energy is a major source of indoor air pollution in developing countries and exposure to its smoke is deleterious to human health. Knowledge, perception and awareness of cooks is key to developing and implementing necessary interventions in kitchens. School kitchens in Ghana rely heavily on solid fuels for cooking. However, no published data exist concerning awareness of cooking-related air pollution and smoke inhalation symptoms. This study assessed the knowledge, perceptions and awareness of air pollution from cooking and the symptoms of smoke inhalation among high school cooks in Kumasi Metropolis, Ghana. This study employed a cross-sectional design to collect quantitative data from 293 respondents. A total of 60% of the respondents had some level of awareness of indoor cooking air pollution. The majority of the respondents had suffered from respiratory symptoms for some time. Over 70% of respondents reported cough, difficulty breathing, catarrh, shortness of breath, headaches, runny nose, nasal blockages, dry and sore throat, red and watery eyes, and eye irritation from their work environment. Approximately 65% of respondents perceived indoor air pollution in kitchens to be high, 19% rated it moderate, 5% deemed it low, and 11% perceived none during cooking. Over 90% of respondents perceived the indoor air in kitchens to be hot and smoky. Regarding the potential cause of disease from biomass exposure in school kitchens, 19.1% of the respondents affirmed the occurrence of hypertension, and 9.9% affirmed the occurrence of asthma. The higher prevalence of smoke inhalation symptoms reported in this study could be due to the absence of intervention in the kitchens. The study suggests interventions such as the adoption of cleaner cooking fuel and technologies in school kitchens to alleviate health and respiratory symptoms from exposure to occupational cooking smoke.</p> Graphical abstract <p></p>