The aim of the present study was to test a path model of the relation between psychological workload and neck/shoulder symptoms with general fatigue as a proposed mediating variable. In this longitudinal two-wave cohort study a questionnaire survey was conducted among female childcare workers. The analyses were based on initially symptom free participants (n=388). Two models were tested, with fatigue at baseline and at follow-up as the proposed mediators, respectively. The results indicate that appraised psychological workload is related to the development of symptoms measured at an 18-month follow-up. The results further indicate that this relation may be partially mediated by general fatigue (also measured at follow-up). The findings of the present study emphasize the importance of the psychological workload in the development of neck/shoulder symptoms among childcare workers. This means that in addition to workplace ergonomic interventions it is important also to pay attention to the psychosocial conditions in order to reduce these symptoms.