Abstract: At about 11:15 a.m. on September 12, 1994, Employee #1, of El Torito Grill, was making tortillas in a tortilla press when his left hand was caught between hot plates heated to about 400 degrees Fahrenheit. Suffering third-degree burns on his hand and fingers, Employee #1 was taken to Hoag Hospital in Newport Beach. His little, ring, and middle fingers were surgically amputated on September 16, 1994. The press consists of a bottom plate that moves back and forth horizontally and a top plate that moves vertically. Both plates are heated, and they cycle automatically. As the bottom plate slides out from under the top plate, tortilla dough is placed on it, then it moves under the top plate, which comes down, presses, and cooks the tortilla. The accident happened when the press completed a cycle and Employee #1 did not remove the cooked tortilla immediately. As the tortilla moved in again under the top plate, Employee #1 tried to grab it and his left hand became caught between the two plates. The accident occurred because the press was unguarded; the cook installed the guard after the accident. A serious violation citation of T8CCR 4184(b) was issued.