Abstract: Employee #1 was working on a vacuum forming machine. A plastic sheet was placed on a sheet holding frame. The frame is on a shuttle that is then entered into an oven to soften the plastic. It was management policy that while the mold was in the oven under the plastic sheet it be blown with air to remove chips or debris. It was also required that an overheated mold be cooled by water and then dried by air. Employee #1 was reaching into the oven to cool the mold when the holding frame reached the point in the timed sequence at which hydraulic pressure automatically lowered the plastic onto the mold, followed by vacuum pressure. The employee's upper shoulders, neck, and head were pinned between the plastic holding frame and the aluminum mold. Because of the pressure, the mold moved and the shuttle moved out of the oven. Another employee saw the accident and came to the machine's controls to release Employee #1 from the mold and frame. Employee #1 required hospitalization.