The purpose of this study was to examine how perceptions of distributive and procedural fairness moderate the relationship between innovative behavior and stress. The results of a survey carried out among 118 first-line managers from six organizations in the public health domain demonstrated that innovative behavior was positively related to the stress reactions of job-related anxiety and burnout only when levels of both distributive fairness and procedural fairness were low. Copyright (C) 2004 John Wiley Sons, Ltd.