The problem of pilot fatigue, identified as a contributing factor in aircraft accidents by the United States National Transportation and Safety Board (NTSB), lacks a concrete measurement method as per 14 CFR Part 117. This research gap is relevant for the aviation industry and public safety, emphasizing the need for a reliable fatigue assessment tool. The NTSB recommends a technology-based solution, prompting this study to explore factors influencing U.S. airline transport pilots’ willingness to use personal fatigue monitoring technology (FMT) to gauge fatigue levels. Applying the Extended Technology Acceptance Model, this study tested 10 hypotheses through an online survey distributed to certified airline transport pilots. Confirmatory factor analysis and structural equation modeling revealed that a modified model was applicable, with six hypotheses supported. Key findings indicated that perceived usefulness and ease of use significantly influenced pilots’ intention to use FMT. Job relevance, results demonstrability, and perceived image positively affected perceived usefulness, while subjective norms influenced perceived image. The study recommends device enhancements aligning with aviation needs and user-friendly data presentation to promote FMT adoption among the 87% of pilots already wearing watches during flights and the 40% using some form of FMT.