Presenteeism is problematic since it relates to lower health and productivity. Prior research examined many work and attitudinal variables relating to presenteeism at the individual level. Here, we conceptualize presenteeism as multilevel phenomenon also shaped by the overall attendance behavior (absenteeism and presenteeism) at the work unit. We surveyed employees at a manufacturing plant on presenteeism, health-related lost productive time (HLPT) and absenteeism (N = 911, 22 units) and collected preceding (past 12–7 and 6 months) objective absence data aggregating it at unit level. Considering the individual-level antecedents only higher physical demands predicted higher absence duration. Presenteeism related positively to physical demands, a burdensome social environment, and organizational identification and negatively to ease of replacement, and core self-evaluations. These relationships were similar for HLPT as outcome. Regarding unit-level factors, preceding unit-level absence frequency (but not duration) negatively related to presenteeism. The negative relationship between core self-evaluations and individual presenteeism decreased under a stronger presenteeism context supporting the hypothesized cross-level effect of unit-level presenteeism context strength. Moreover, individual and unit-level presenteeism correlated, as expected, more strongly with health complaints than absenteeism. Our study demonstrates the value of a contextual, multilevel approach for understanding antecedents and consequences of attendance behavior.