Human biomonitoring (HBM) as a tool for occupational exposure assessment has been reviewed, with a specific focus on pesticides. A systematic literature review (SLR) of available information on HBM of pesticides (or their metabolites) in occupational settings and from HBM studies/surveillance programmes has been carried out and the studies identified assessed for relevance and quality. HBM essentially involves the quantification of either a substance, one of its metabolites, or a surrogate marker of its effects in a biological sample obtained from a person who may have undergone an exposure. Thus, HBM is generally considered to be an estimate of exposure, rather than a measure of health. Over the past 10 to 20 years there has been an expansion in the use of HBM, especially into the field of environmental and consumer exposure analysis, and it is currently well-developed and widely used in both the occupational and environmental settings worldwide. As with any tool, HBM has its strengths and weaknesses and appreciation of these promotes the development of approaches to minimise their effects. Although HBM has been extensively used for monitoring worker exposure to a variety of pesticides, epidemiological studies of occupational pesticide use were seen to be limited by inadequate or retrospective exposure information. Very limited data was identified examining seasonal exposures and the impact of PPE, and many of the studies used HBM to assess only one or two specific compounds. A wide variety of exposure models are currently employed for health risk assessments and biomarkers are often used to evaluate exposure estimates predicted by a model. From the 178 publications identified to be of relevance, 41 individual studies included herbicides, 79 individual studies included insecticides, and 20 individual studies included fungicides. Remaining studies related to mixtures or non-specific biomarkers for groups of pesticides. Although a number of current limitations were identified, there is evidence within the literature for a potential role of HBM in occupational health and safety strategies, as both a tool for refined exposure assessment in epidemiology studies and to contribute to the evaluation of potential health risks from occupational exposure to pesticides. Some key issues were considered that would need to be overcome to enable implementation of HBM as part of the occupational health surveillance for pesticides in Europe. These included issues around priorities for the development of new specific and sensitive biomarkers, the derivation and adoption of health-based guidance values, development of QA schemes to validate inter-laboratory measurements, good practice in field work and questionnaire design, consideration of the extended use of biobanking and the use of HBM for post-approval monitoring of pesticide safety.