Introduction: Globally, food and waterborne diseases remain a critical public health problem, although the issue is severe in low and middle-income countries, including Ethiopia. This study aimed to identify factors associated with food safety practices and the drinking water quality of food establishments. Method: A cross-sectional study was conducted. A total of 160 food outlets were enrolled using a systematic random sampling method. A structured questionnaire and observational checklist were used to collect data. Descriptive, binary, and multivariable logistic regression analyses were conducted. Drinking water samples were taken from the food establishments' drinking-water storage and were bacteriologically and chemically tested. Heat-sterilized bottles of 250 ml capacity for bacteriological and 1000 ml plastic bottles for chemical parameters were used to collect drinking-water samples. Results: In this study, food establishments with female managers were 3.7 times higher in good food safety practices than those with male managers (AOR = 3.7, with 95% CI 1.33–10.21). Moreover, food establishments that owned trained food handlers in sanitation and hygiene were 4.8 times more likely to be in good food safety practices than those that did not have trained food handlers (AOR = 4.8, with 95% CI 1.37–17.00). Besides, food outlets with large service were 9.6 times higher in good food safety practices than those with small service (AOR = 9.6, with 95% CI 2.2–42.1). On the other hand, food outlets which had married managers were 0.3 times less likely to be in good food safety practices than those food establishments which had single managers (AOR = 0.3, with 95% CI 0.11–0.93). In this study, only 51% of the food establishments had good food safety practices. Besides, 29.5%, 16.8%, and 7.4% of the food outlets’ drinking-water samples were positive for total coliforms, fecal coliforms, and E. coli, respectively. Conclusion: Many vital factors influencing the food safety practice of food establishments were identified. Almost half of the food outlets had poor food safety practices. A significant number of drinking water samples from the food outlets' were contaminated. Therefore, food establishments should implement continuous monitoring and inspection systems to improve food safety practices. In addition, the government should implement an effective regulatory system to improve the food safety practices, water quality, sanitation, and hygiene services of the food outlets.
