Abstract: At 3:00 p.m. on April 8, 2004, Employee #1 was working with an unguarded letter press. The business manufactures promotional buttons from a 4500 square foot building in North Las Vegas, Nevada. The establishment has been in business in Nevada for 3 years and can manufacture approximately 15,000 buttons per day during peak business. At the time of the accident, Employee #1 was working on a Brandtjen and Kluge letter press that was outfitted with a die to score around the established emblem of the button design. The emblems were arranged six to a page, and the pages were manually inserted and removed by Employee #1. During operation, the full revolution, multiple stroke press operated at rate of approximately one revolution per second, and Employee #1 was required to reach into the point of operation while the machine cycled to add and remove the paper stock. At the time of the accident, Employee #1 was working at a rate of 300 sheets every 20 minutes. While reaching into the point of operation, to retrieve the scored paper, the die closed and amputated the middle three fingers of Employee #1's left hand. Local emergency services were called, and Employee #1 was transported to a local trauma center, where the fingers were unable to be reattached. Employee #1 was treated and released from the hospital four days later.