Abstract: Employee #1 worked for a company that performed metal alloy injection molding. This involved melting metal in a furnace and then injecting it into a die. Employee #1 tried unsuccessfully to light a cold furnace using the standard procedure, then asked a coworker for help and opened the furnace door. While the coworker held down the gas and ignition switch, Employee #1 placed a lit piece of cardboard directly onto the furnace burner. The furnace ignited instantly, taking Employee #1 by surprise. He was standing in a flareback area and sustained minor burns. A furnace company called in to analyze the burner's failure to ignite determined that the air control mechanism, which supplies air for the air/fuel mixture, was defective. By opening the furnace door and holding down the switch, Employee #1 had bypassed the safeties that fed gas into the burner. With the blower set at high flow, the furnace lit once a source of ignition was introduced. Employee #1 later stated that he and his coworkers had previously used this method to light furnaces, but that it was not in line with the employer's procedures.