In 2000, two years after his retirement from playing, Worsfold joined as an assistant coach, remaining in this position until the end of the 2001 season, when he was appointed senior coach of West Coast in place of Ken Judge. Worsfold coached the club in eight finals series, including the 2006 premiership. In 2010, he coached West Coast to its first wooden spoon, but the following season the team finished fourth, with Worsfold receiving the AFLCA Coach of the Year Award for the second time. He coached West Coast in a club record 274 games before resigning at the end of the 2013 season. He was named an inaugural inductee into the West Australian Football Hall of Fame in 2004 and the John Worsfold Medal is named in his honour.