Abstract: At approximately 10:20 a.m. on July 21, 2001, Employee #1, a cloth pressing and hanging worker, was performing her duties at a laundering, dry cleaning and pressing/ironing establishment. She was in the second floor pressing room of the facility, pressing pants with a pneumatic Ajax legger/topper utility steam press (Serial Number SPKA1063694). Employee #1 was working alone, standing in a normal operating position in front of the press. Her immediate supervisor was in his office at the time of the accident. The press used a two-handed button control. Both the left red button and the right green button had to be pressed to activate and close the head of the press. However, the two buttons did not have to be concurrently pressed. A third button (a green one on the left) released the head so that it could return to the open position. Vacuum and pressure were controlled by a foot pedal. While reaching for a pair of pants to be pressed, and positioning them in the proper place on the press with her right hand, Employee #1 would press the left operating button with her left hand and continue to hold the pants in place. In this way, depressing the right button was all that was required to operate the press. At the time of the accident, the right operating button had become stuck in the downward position, allowing the press to be activated by depressing the left button only. While positioning a pair of pants onto the press, Employee #1 depressed the left operating button, causing the press to operate. The head came down and burned her right hand and forearm. She was initially transported to Pacific Alliance Medical Group, but was subsequently transferred to Grossman Burn Center, where she was hospitalized and treated for third degree burns over her right hand and forearm, including a skin grafting operation. It was determined that the accident was caused by insufficient guarding provided on the two-hand controls of the laundry press. Because the operating controls were not concurrent, the press could be activated with only the left button when the right operating button became stuck, allowing Employee #1's arm to become caught between the ironing surfaces of the press.