Flexible work arrangements such as telework are gaining importance. Although telework is accompanied by advantages for employees such as increased flexibility, current research reveals associations between home-based telework and self-endangering behavior such as sickness presenteeism. As empirical evidence is still scarce, we explore the relationship between home-based telework and sickness presenteeism across Europe. We perform multilevel analyses including 25,465 individuals who responded to the 6th wave of the European Working Conditions Survey 2015. Home-based telework is positively related to sickness presenteeism. The results are quite robust across different measures of sickness presenteeism and to several sensitivity analyses. Although sickness presenteeism can be functional for specific illnesses, organizations should be aware of possible risks related to home-based telework. They should design telework in a way that it reduces triggers for self-endangering behavior.