Abstract: At 7:00 a.m., Employee #1 reported for work at a tortilla chip processing line that used a Casa Herrara, Inc., oven and conveyor system, model #TCH1039, serial #98011473. Line #2 was down for a change over of product. When the line was ready to start, Employee #1 noticed some spoiled corn matter on the rollers and also that some of the roller bands were defective. She dumped the bad corn, and a coworker replaced the defective bands. Employee #1 washed the rollers of the sheeter, cleaned the rollers with a scrapper, and rinsed the rollers, before removing the lockout from the equipment. She then started the sheeter so that she could see if the rollers were clean. She noticed some debris on the rollers and, without reinstating lockout procedures, opened the back and top guard to gain access to the rollers. The top of the rollers was approximately 75 in. from the floor and set back approximately 20 in. from the frame. To gain access to the in-running nip point, she used a four-legged metal stool. She was standing on the stool when she inadvertently dropped the scrapper above the two in-running rollers. She reached for it with her right hand at the same time that she tried to deactivate the sheeter with her left hand by opening a guard that was equipped with an interlocked part. Employee's #1 right thumb became caught between the two in-running rollers and was amputated.