BackgroundAs “stay at home” orders were in effect, many US food workers attended in-person work during early phases of the COVID-19 pandemic, charged with maintaining normal operation of the national food supply chain. Despite establishment of a novel national paid sick leave policy, anecdotal evidence suggests that many U.S. food system workers encountered barriers to staying home when ill.MethodsUsing quantitative and free-text analyses from a national, cross-sectional, online survey deployed from July to October 2020 among 2,535 respondents, we explored workplace and non-workplace factors associated with U.S. food system workers’ intentions to attend work while ill (i.e. presenteeism intentions) during the first four to six months of the COVID-19 pandemic.ResultsOverall, 8.8% of workers surveyed reported intentions to attend work while ill. Both quantitative data and free-text responses suggest that aspects of workplace culture influenced workers’ decisions to attend work while ill. Workers reporting a high workplace safety climate score had half the odds of reporting presenteeism intentions (adjusted odds ratio [aOR] 0.52, 95% confidence interval (CI) 0.37, 0.75) relative to those reporting low scores. Workers described cultural barriers, including retaliation and penalties, that reduced paid sick leave access. Workers reporting low (aOR 2.06, 95% CI 1.35, 3.13) or very low (aOR 2.31, 95% CI 1.50, 3.13) levels of household food security had more than twice the odds of reporting presenteeism intentions.ConclusionsThis study offers insights into opportunities for reducing presenteeism related to illness among food workers both during the COVID-19 pandemic and in other infectious disease scenarios. Addressing vulnerabilities like food insecurity and empowering food system workers to make health-protective decisions is important both for optimal worker health outcomes and maintaining a functioning food system.