As flu season approaches, a study suggests somewhere the germ-wary might want to avoid: restaurants. In a national survey of 4,323 waiters, chefs and sandwich makers, 63 percent said they went to work ill within the past year.

The survey is part of the report, “Serving While Sick,” which was commissioned by a restaurant labor group and funded by such institutions as the Ford Foundation and Rockefeller Foundation. The report concludes that the lack of both paid sick leave and health insurance spurs many restaurant employees to work even when they are ill.

Nearly nine in 10 food service workers said their employer didn’t offer paid sick days, and only one in 10 workers said they received health insurance through their employer. More than six in 10 said they had no health insurance at all.

Scott DeFife, a representative of the National Restaurant Association, an industry group, said the report presented a “distorted image of the restaurant industry and its employees” while pushing a labor agenda, McClatchy Newspapers reports. DeFife said his restaurant association supports paid time off and flexible work hours to meet employee needs.

He also said that many restaurants, contrary to what the report concluded, offer paid sick days.

Restaurants workers aren’t the only ones going to work ill, the McClatchy article pointed out. A recent study published in the Journal of the American Medical Association found that nearly 58 percent of 537 medical residents surveyed in hospitals around the country had worked while sick.