This research focused on Occupational Therapy status and challenges in a tertiary institution, Port Harcourt, Rivers State in 2021. The study determined prevailing Occupational Therapy status, identified challenges against adequate Occupational Therapy facilities, evaluated any prevention and control measures to checkmate the challenges facing Occupational Therapy services and endeavoured to compare past and present perceived Occupational Therapy status in the tertiary health institution. A descriptive research design was adopted. The population for the study was 869 and a sample size of 383 drawn out as its 44.07%. The major instrument for data collection was a well-structured and validated questionnaire with reliability index of 0.99. Observation with checklist was an added instrument for primary data collection. A multi-stage sampling procedure was applied in this study. The data obtained were tallied, summarized, coded and presented in frequency Tables and analysed using percentage. Findings on current Occupational Therapy status included deteriorating state of students’ hostels (82.40%), delayed removal of heaped refuse (78.67%), prolonged blockage of drainage channels (76.80%), crowded office accommodation for staff (84.53%), worsening state of staff offices and class-rooms (79.73%), non-regular maintenance of offices and class-rooms, e.g. rare cleaning of the few functioning fans (80.27%),  non-conducive offices and class-rooms especially due to unreliable electric power supply (91.47%), and irregular water supply to all parts of students’ hostels and many staff offices (97.87%). The above findings pose a great challenge to optimum Occupational Therapy besides inadequate environmental sanitation exercises (95.20%), poor flood control (96.00%), little or no funding of the institution of learning by the authority concerned (76.27%) and inadequate government provision of modern equipment to the schools and demonstration clinic (85.07%). The study also revealed on-going control and prevention on issues militating against adequate Occupational Therapy services to comprise ensuring improved waste management (54.40%), opening alternative drainage channels (77.87%), maintaining good sanitary status of the operating public convenience (63.20%), engaging in regular grass cutting to avoid biological hazards (71.73%), and encouraging students’ participation in health care (69.87%).  There was clear difference in Occupational Therapy status in the institution between 2015 and 2021, p>0.05 with the former standard being high. Therefore, it was recommended that the management of the institution should regularly clear the main drainage channel linking it to larger gutter at its end, engage on constant surveying to discover water-logged areas and act accordingly, embark on quick removal of solid wastes, employ more qualified personnel at the demonstration clinic and vigorously pursue attracting funding to the institution along with providing improved Occupational Therapy services for its workers.