Worker fatigue is an important risk factor in civil engineering and construction projects, particularly when night-time shift working is required. It is a significant cause of accidents and negatively affects health and well-being. Biomathematical models can be used to assess and reduce fatigue risk. Research funded by Tideway, the company delivering London’s Thames Tideway Tunnel, was carried out to explore the current use and knowledge of such models in tunnelling, and to produce guidance on how the models can be used for fatigue management within the wider construction industry. The research identified limitations in how the tunnelling sector currently applies fatigue modelling. Knowledge and understanding of the models need to increase throughout construction for them to be effective and used appropriately. It is also important for an industry consensus on acceptable fatigue risk to be reached.