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.