Abstract: On October 26, 2002, Employee #1 of Goglanian Bakeries Inc. was cleaning and sterilizing various pieces of equipment used in the baking process. The cleaning process takes place in a 30 feet by 30 feet washroom, consisting of a hose, ladder and an electrical plug/cord assembly. Employee #1 was hosing off the Number 2 dough incline conveyor system, which is approximately 12 foot long with a 2.5 foot conveyor belt used to transfer dough from a mixer to the divider. The conveyor system is 2 feet off the ground and inclined more than 7 feet. During cleaning, the conveyor is unplugged and taken out of the baking process area to the wash room where it is plugged into a 280 volt three phase connector. The conveyor is then activated and cleaned with scrapers, brushes, and water under pressure. Employee #1 was a sanitation operator, working full time for the employer. The accident took place when a mechanic entered the washroom and asked Employee #1 if he could borrow the hose to rinse some parts. Employee #1, who was half way up a 6 foot ladder, handed the mechanic the hose. Employee #1 then noticed a glob of dough on the running conveyor belt near the motor at the top of the conveyor system. As he reached for the dough, his neoprene glove became caught, drawing his left hand and arm into the conveyor system. When the conveyor system operated in the baking process the belt runs clockwise, in the washroom the three phase sequence in the electrical wiring is reversed, causing the conveyor system to run counter clockwise. The counter-clockwise action created a pinch/drawing point only during operation in the washroom. Employee #1 suffered a dislocated shoulder and abrasions to left forearm, left ring finger, and left middle finger. These injuries became serious when infection set in and two skin graft operations were performed. Employee #1 was hospitalized.