The scientific literature about presenteeism among farm workers is scarce. This study estimated the prevalence of and factors associated with presenteeism among paid fruit farm workers. A cross-sectional study investigated 340 paid employees of both sexes, aged 18 years or above, who worked during the 2019 irrigated fruit harvest in the municipality of Petrolina, Northeast Brazil. Information about sociodemographic characteristics, lifestyle, general health status, occupational characteristics, interpersonal work aspects, and the work environment’s structural characteristics was collected in a structured questionnaire. Presenteeism was established when participants reported working one or more days during the previous season despite feeling ill or when injured. Cox regression was used to estimate prevalence ratios adjusted by sex, area of residence (urban or rural), employment contract (permanent or seasonal), satisfaction with management, participation in workplace decision-making, availability of on-site healthcare facilities, and on-site availability of sunscreen. The prevalence of presenteeism during the previous season was high: 58.2%. In the final multivariate model, the adjusted prevalence ratio was higher (≥1.20) among female workers (1.42), workers dissatisfied with management (1.28), and those for whom sunscreen was not available on site (1.61). The prevalence of presenteeism was high and associated with personal, work organizational, and workplace resources characteristics.