Abstract: On August 1, 2001, Employee #1, a machine operator, was assigned to press bushings. Since the regular press was out of service and was being repaired, Hannifin Press Number 131 was put into service to complete the task. Employee #1 was assigned to a sway bar assembly on the Hannifin Press which was not adequate for the task, because it exposed Employee #1's hands to a pinch point. Employee #1 had to expose his hands to the ram while pushing in the sway bar. While positioning the bushing on the work piece, Employee #1 accidentally stepped on the pedal and cycled the machine. His fingers were caught in the machine, amputating two of them. Employee #1 was hospitalized for his injuries. Employee #1 was not instructed or trained on this equipment.