This study aimed to assess the potential risks posed by heavy metals in sewage sludge (SS) produced by municipal wastewater treatment plants (WWTPs) in the most industrialized region in Poland, the Silesian Voivodeship. The ecological risk was assessed using three indices: the Geoaccumulation Index (I_geo), Potential Ecological Risk Factor (ER), and Risk Assessment Code (RAC), while the health risk was estimated by using carcinogenic and non-carcinogenic risk indices. The average concentrations of metals in the sludge samples were determined revealing that Zn was the predominant element, whereas Cd and Hg were present in the lowest concentrations. The study showed that the processes used in wastewater treatment plants influenced the overall metal content and chemical speciation. According to I_geo values, the dewatered sludge samples exhibited higher contamination levels of Cd and Zn, while Cu and Pb were upon to a lesser extent. The ER values suggest that Cd and Hg present the highest ecological risk. Considering the chemical forms and RAC values, Ni (26.8–37.2%) and Zn (19.8–27.0%) were identified to cause the most significant risks. The non-carcinogenic risk for adults and children was below acceptable levels. However, the carcinogenic risk associated with Ni (WWTP1) for both demographic groups and Cr and Cd (WWTP2), specifically for children, exceeded the acceptable threshold. Ingestion was the primary route of exposure. Although the dewatered SS met the standards for agricultural use, there is still a risk of secondary pollution to the environment and possible adverse health effects.