Abstract: On May 22, 2008, Employee #1 was installing a 1-in. thick metal plate onto the upper bolster plate of a 60-ton mechanical power press. He did not use the proper lock out/ tag out procedures and/or the use of die blocks. In addition, the foot pedal was not guarded. While he worked, someone may have inadvertently stepped on the pedal actuator, which caused the press to cycle and crush Employee #1's right hand. Employee #1 was transported to a medical center, where he received treatment and underwent surgeries, which included the amputation of his hand. Following the medical procedures, he was hospitalized.