Background: Tuberculosis (TB), caused by mycobacterium tuberculosis, remains key global public health concern in terms of morbidity, mortality and cost for care. Objective: The study aimed at assessing sputum smear positivity and associated factors among TB suspected patients in Bahir Dar City, Ethiopia. Methods: Facility based cross sectional study was conducted among 283 TB suspected patients in2016. Data were collected using structured interviewer administered questionnaire, and processing of the leftover sputum samples. Spot-morningspot sputum samples were collected, processed, and examined using Olympus microscope. Patients were grouped as positive if two sputum smears became positive. Data were edited and analysed using the SPSS verssion22. Various descriptive statistics were computed and factors to smear positivity were identified by multivariable logistic regression analysis and odds ratio at 95%CI and p-value <0.05 were considered to determine presence of statistical association. Results: A total of 283 TB suspects, 142(50.2%) male, were included in the study. Over half (55.8%) of them were under <35 years age category, and majority (70.3%) were Orthodox Christians. Over a third (35.7%) respondents had no education, and 72.4% of them were unemployed. The prevalence of smear positive pulmonary TB among participants was 43(15.2%) or (1519/100000). Younger age, cough ≥ 2weeks, no education, purulent sputum, HIV/ AIDS, sputum collection orientation, sputum coughed from lung and staining quality were statistically significant (p-value <0.05) and showing positive association with smear positivity. Conclusions: This study showed the presence of high smear positive pulmonary TB among TB suspected patients. This clearly indicates that TB continues important public health challenge in Ethiopia. Patient factors, duration of cough, sample related characteristics, laboratory personnel related factors, and being HIV/AIDS patient statistical significant factors to sputum smear positivity. Improving TB suspected screening, staining quality, sample collection, and adherence to the national TB laboratory standards is crucial to increase smear positivity.