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Objective To develop a fatigue assessment scale and test its reliability and validity for commercial construction workers. Methods Using a two-phased approach, we first identified items for the development of a Fatigue Assessment Scale for Construction Workers (FASCW) through review of existing scales in the scientific literature, key informant interviews (n=11) and focus groups (3 groups with 6 workers each) with construction workers. The second phase included assessment for the reliability, validity and sensitivity of the new scale using a repeated-measures study design with a convenience sample of construction workers (n=144). Results Phase one resulted in a 16-item preliminary scale that after factor analysis yielded a final 10-item scale with two sub-scales (“Lethargy” and “Bodily Ailment”).. During phase two, the FASCW and its subscales demonstrated satisfactory internal consistency (alpha coefficients were FASCW (0.91), Lethargy (0.86) and Bodily Ailment (0.84)) and acceptable test-retest reliability (Pearson Correlations Coefficients: 0.59–0.68; Intraclass Correlation Coefficients: 0.74–0.80). Correlation analysis substantiated concurrent and convergent validity. A discriminant analysis demonstrated that the FASCW differentiated between groups with arthritis status and different work hours. Conclusions The 10-item FASCW with good reliability and validity is an effective tool for assessing the severity of fatigue among construction workers.