Abstract: At about 1:30 p.m. on June 7, 1998, Employee #1 was working on a printer and coater machine on the third floor. He was trying to clean the Doctor Blade so that ink stains would not come on the paper. In order to clean the blade he had to adjust the blade by rotating an adjusting wheel. Employee #1 had adjusted the wheel, and as he tried to get out from under the rolls, he lost his balance and fell forward hitting his forehead on the roll. At the same time his right hand got caught in the running roll and amputated his right index and middle fingers. Right after the accident Employee #1 was taken to Techno Medical Industrial Clinic and later he was transferred to Western Hand Center. One week after the accident, surgery was performed on his hand. Employee #1 stated that he was not instructed to turn off the power on the machine, while cleaning or making adjustments on the machine.