Abstract: After lunch on November 7, 2005, Employee #1 complained of chest tightness, heart burn, and trouble breathing. At approximately 1:30 p.m., a supervisor instructed him to go to the hospital. Employee #1 walked to his car, collapsed in the parking lot and died. Jackson County Medical Examiner determined the cause of death was a heart attack. Employee #1 had sprayed HDI-containing liquids for approximately five years prior to death. HDI is a sensitizer and can result in severe, life threatening asthma attacks due to hypersensitivity pneumonitis. The employer manufactured aftermarket automotive and truck panels and equipment. Two separate coating operations utilized isocyanate formulas as hardening agents. An automotive spray coating process used hexamethylene diisocyanate (HDI) and methylene bisphenyl isocyanate (MDI) containing hardeners during multiple two part paint applications. MDI was also used as the hardener in a large foam panel spray coating process that resulted in a bed liner type coated panel. Main hazards and issues involved employee respiratory and skin protection during exposure to HDI and MDI. Material safety data sheets were not maintained. The respiratory protection program was not appropriate for the exposure, respirator type, use of respirators, or fit testing. In addition, respirator use ranged from half face air purifying respirators to supplied air respirators with a hood and tight fitting full face piece.