Liberia and other low and middle-income countries (LMICs) are particularly vulnerable to climate change. Yet, data on perceived risks of climate change among community residents in these countries are little known. We performed a cross-sectional survey of 800 households selected randomly through multistage cluster sampling from two regionally distinct areas of Liberia. A 91-item English survey was administered by trained research assistants verbally in the respondent’s preferred spoken language. Univariable comparison of climate related questions between the two regions was made by chi-squared analysis. Univariable and multivariable logistic regression modeling was performed to assess the association between known risks and the primary outcome of interest: a self-reported increase in health emergencies due to extreme heat, drought, flooding, wildfires, or other extreme weather events by climate change. Survey respondents were majority male (n = 461, 57.8%) with a mean age of 40.6 years (SD 14.7). Over 65% of households lived on less than 100 USD per month. A majority of respondents reported increased intensity of heat during the dry season (n = 408, 51.0%); increased intensity of rainfall during the rainy season (n = 433, 54.1%), and increased severity in endemic diseases (n = 401, 50.1%) over the past 5–10 years. In multivariable modeling, perceived water and food impacts (OR: 6.79, 95%CI 4.26–10.81; OR: 3.97, 95%CI 2.25–7.03, respectively), unemployment (OR: 3.52, 95%CI 1.89–6.56), and lack of electricity (OR: 2.04, 95%CI: 1.23–3.38) were the strongest predictors of perceived increased health emergencies due to climate change. A significant proportion of households across multiple Liberian communities have already felt the health effects of climate change. Focused efforts on mitigating individual and household risks associated with the increased health effects of climate change is essential.