Risk assessment provides the scientific basis for establishing exposure limits and regulatory measures to safeguard workers and the general population from the harmful effects of pesticides. The objective of this systematic review, following the PRISMA guidelines, is to assess whether the assessment of pesticide exposure in agricultural workers is considered crucial for promoting good practices suggested in the field of occupational health and safety. Additionally, if the evaluation and analysis of risks of exposure to pesticides in agricultural workers is done by the companies themselves or by the entities responsible included in the occupational risk assessments developed. A search of four databases identified 25 articles that addressed pesticide exposure in risk assessment or the development and use of tools in this area using methodologies that focused on determining dermal and inhalation exposure, both potential and actual. Biomonitoring was also used as a complementary method to determine dermal and inhalation exposure. The studies indicate that companies do not consider pesticide exposure assessment when identifying and assessing risks associated with their activities. To improve understanding and prevent risks to workers’ health, conducting more quantitative and comprehensive toxicity assessments of active substances used in agricultural practices is necessary.