Background: Influenza is a substantial threat to healthcare settings, and the annual influenza vaccine (IV) is an effective preventive measure against influenza. However, the vaccination rate among health care workers (HCWs) remains low. Objective: This study aimed at assessing vaccine coverage among HCWs at the primary health care centers of the Saudi Ministry of Health (MOH), and determine factors affecting compliance to vaccination. Methods: We conducted a cross-sectional study, and by applying a multistage clustering sample method, we randomly selected 83 male and 202 female HCWs. We used a self-administered questionnaire to collect information about IV uptake and its determinants. We performed the chi-square test to define associated factors and used binomial logistic regression analysis to determine the unconfounded predictors of IV. Results: The rate of IV among HCWs ranged from 53.3% during 2016 to 51.7% during the 2018 season. Compliances to successive vaccination over the past three years were only 30.2%; however, 66.2% of HCWs intended to receive the vaccine during the upcoming season. The main reasons for IV uptake included self-protection against influenza (60.7%) and caring about client's patients (44.8%). Single female nurses were more likely to be immunized against IV than other HCWs p<0.05. Both reading the official MOH IV guidelines and feeling of having sufficient knowledge about IV were unconfounded predictors for the vaccine. Conclusion: The overall immunization coverage was suboptimal, and the fact that reading the official MOH IV guidelines had a strong statistical association with a positive attitude towards vaccination emphasizes the role of governmental authorities in enhancing vaccine among the HCWs.