Abstract: On June 26, 2003, Employee #1, a worker in an automobile electrical parts manufacturing facility, was working in the solenoid crimping and tear down shop. She normally operated the solenoid crimping machine, but her supervisor asked her to operate the solenoid tear down machine, ENERPAC Pump, PED 300B, A1398C, RC1010 Silender. Employee #1 had never worked on this machine. The leaderman of the group gave Employee #1 a five minute instruction on how to operate the teardown machine and she started working. The machine is 2-feet high and is operated through two hand buttons and one foot lever. The hand buttons help to hold the solenoid assembly in position once the bobbin assembly is placed into the solenoid housing. The foot pedal is used to actuate the ram (stroke of 12 inches), moving it down to knock the bobbin from the assembly. Towards the end of the batch run, with only about two or three pieces left, Employee #1 pressed the left hand button and activated the foot pedal without pressing the right hand button. As the ram came down towards the assembly, Employee #1's right hand was on the solenoid assembly in an attempt to remove it from the inclined position. The ram came down and severed her right index finger at the first digit. Employee #1 was hospitalized at Harbor General Hospital and treated for her injury. A detailed investigation determined that the machine was not guarded at the point of operation.