Abstract: Employee #1 was operating a printing press on which he had minimal training. When paper in the press jammed, he shut off the machine, cut the paper loose, grabbed the end of the paper with his fingers, and attempted to push the jog button. Employee #1 inadvertently pushed the run button, which was close to the jog button. The employee's fingers, hand, and arm were pulled into the press rollers and fractured in several places. The employer had no written procedures for unjamming the press and no written lockout/tagout program. The machine was improperly guarded and not equipped with a safe mode.