Abstract: ON APRIL 10, 1984, AT APPROXIMATELY 7:30 PM, EMPLOYEE #1 WAS INJURED WHILE WORKING ON AN L & J FULL REVOLUTION PRESS, NUMBER 5, SHOP NUMBER 6. HIS LEFT RING AND LEFT MIDDLE FINGERS WERE AMPUTATED AT THE FIRST JOINT. HIS LEFT RING FINGER WAS BRUISED AND TURNED BLACK. PULLBACKS WERE USED AS A MEANS TO GUARD THE POINT OF OPERATION. THE EMPLOYEE WAS RUNNING A JOB WHICH REQUIRED HIM TO LOAD THE PART WITH HIS LEFT HAND AND STROKE THE PRESS WITH A FOOT PEDAL. WHENEVER THE EMPLOYEE RAN OUT OF PARTS TO FEED, HE WOULD UNHOOK THE PULLBACK ON HIS LEFT HAND, THEN USE HIS LEFT HAND TO SCOOP MORE PARTS OUT OF A BOX ON THE FLOOR. EMPLOYEE #1 HAD BEEN RUNNING THE PRESS SINCE THE BEGINNING OF THE SHIFT AND HAD BEEN WEARING THE PULLBACK DEVICES. IMMEDIATELY AFTER THE PRESS ACCIDENT, IT WAS DISCOVERED THAT EMPLOYEE #1 WAS WEARING THE RIGHT PULLBACK BUT NOT THE LEFT. THE CSHO FEELS THAT THE ACCIDENT WAS A RESULT OF AN ISOLATED EVENT. MANAGEMENT WAS NOT AWARE THAT THE EMPLOYEE WAS NOT WEARING THE LEFT PULLBACK. THE EMPLOYEES WERE AWARE THAT THEY WERE REQUIRED TO WEAR THE PULLBACKS, AND WERE AWARE OF THEIR PURPOSE. ON THE INFREQUENT OCCASIONS THAT THEY DID NOT WEAR THE PULLBACKS THEY WERE REPRIMANDED, PRIMARILY VERBALLY, BY MANAGEMENT. THE EMPLOYEE MAY HAVE FORGOTTEN TO REPLACE THE PULLBACK.