Background <p>Tobacco use is a leading cause of preventable deaths worldwide. Despite national and institutional policies, referral to smoking cessation counseling by healthcare workers in India remains limited. We planned a study to assess the practice of referral for smoking cessation counseling by healthcare workers.</p> Methods <p>A prospective descriptive study was conducted from January to May 2024. A total of 1832 patients were screened for smoking status; 612 (33.4%) were active smokers and 122 (6.6%) were former smokers. Active smokers admitted to the respiratory medicine ward were interviewed regarding smoking cessation referrals. In parallel, 290 healthcare workers (doctors, nurses, and interns) were surveyed using a validated 21-item semi-structured questionnaire. Data were analyzed using SPSS v28.0.1.0 for descriptive statistics and associations.</p> Results <p>Among active smokers, only 265 (43.3%) received cessation counseling. Of 290 healthcare workers, 37 (12.7%) had formal training in smoking cessation counseling. Lack of training and lower education were significantly associated with reduced counseling practices (<i>p</i> = 0.0015 and <i>p</i> = 0.0453). Most healthcare workers (63.7%) rarely assessed nicotine dependence, and 42.3% rarely evaluated readiness to quit.</p> Conclusion <p>Referral for smoking cessation remains inadequate. Regular training, motivation, and accountability measures are essential to improve healthcare workers’ role in tobacco control.</p>