Paramedics, police and Red Cross volunteers were among those given medals for their service.
But it may have been the community's 45 firefighters, who battled the flames for two days following the explosion, and then spent weeks sifting through the rubble, who received the biggest ovation.
"It was very touching to see our work recognized, and also the work of other first responders," said Lac-Megantic fire chief Denis Lauzon.
"Firefighters are on the front lines, but we have we had a lot people working behind us and helping out."
The ceremony was held at the local high school. Only a few months ago it served as a shelter for those displaced following the explosion.
Lac-Megantic mayor Colette Roy-Laroche, who was front and centre following the tragedy, was the first to be honoured with a medal.
Roy-Laroche shed a few tears as she hugged Quebec Premier Pauline Marois.
"Today's ceremony was heartwarming," Roy-Laroche said.
"Taking time to pay tribute like this, it's something we sometimes forget to do in our busy world."
In her speech, Marois told the first responders they were a source of strength across Quebec as residents grappled with the tragedy.
"The people of Quebec thank you for your exceptional service," Marois said.
"Your actions saved lives, and gave a whole community a reason to stand up again."
Following the accident last July 6, firefighters came from across the province and even neighbouring Maine to help out.
A total of 47 people were killed after a runaway train carrying crude oil derailed and exploded near the centre of Lac-Megantic. On Saturday, members of the community lit the same number Christmas trees as a tribute to the victims.