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An experienced press operator was in the process of changing the press dies and cleaning the working bed, without having de-energized the machine. As he was controlling the machine by its clutch, the clutch snapped and the cloth the operator was holding was pulled into the point of operation. The operator sustained lacerations to the bone of three right fingers after the circular bed turned and several punches were performed. Although the employer's written procedure called for "turning off" the machine for clean-up and changing punches, the operator had not been trained on the procedure, or any other safety issues.

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