Abstract: Employee #1, of Johansson Dielectrics, was operating PH press #1 in the screening department. She had not operated this particular press before but she had used another PH press in the screening department for two days over the course of the previous weeks. The process called for placing a metal plate with ceramic sheets onto the press conveyor and then pushing the foot pedal to move the plate into the pressing area of the machine. Employee #1 had been operating the press for approximately 30 minutes and had processed about 40 plates when she noticed that the special paper sheet taped to the upper platen of the press had some of the material from the plates sticking on it. She took off the guard, removed the special paper from the upper platen, and went to cut another piece of paper. She then came back to the press and reached into the point of operation to attach the special paper to the upper platen. In doing so, she passed across the sensor in front of the pressing area and the machine cycled. The lower platen closed on her left hand, crushing it between the press platens. Employee #1 could not remove her hand and she hit the red EMERGENCY STOP button, but this did not open the press. Coworkers responded to her screams and they also tried hitting the EMERGENCY STOP button thinking it would open the press. Employee #1's supervisor then came over and started the press, which opened the platens and freed her hand. Employee #1 suffered amputation of the middle and fourth fingers below the first knuckle, bone loss in her index finger, and loss of fatty tissue on her little finger. She was admitted to Holy Cross Hospital, where she underwent surgery on her fingers. At the time this report was written, Employee #1 indicated that she was scheduled for additional surgery on her index and middle fingers and that she was undergoing physical therapy. Employee #1 had not deenergized the press before replacing the paper on the upper platen.