Abstract: At approximately 10:30 a.m. on April 15, 2007, Employee #1, a conversion machine operator at Omega Extruding Corporation of California, was working on the 214 conversion line. The company manufactured plastic bags for food industries and retail stores, using extrusion, conversion and printing operations. A coworker, who was at the packing station of line 214, noticed poor print quality and he stopped the machine. He walked over to Employee #1, whose station was about 30 feet from the packing station, to report the problem. Employee #1 inspected the print quality and told his coworker that everything was okay. He restarted the machine and his coworker headed back to the packing station. Employee #1 then entered the interlocked area of the conversion line, without stopping the machine, to clean the impression cylinder with rags. He was wearing a long sleeve shirt and latex gloves. The coworker heard Employee #1's scream when he got back to the packing station and he pressed the emergency stop button to stop the machine. The coworker then went to another worker to report the accident. They returned to the 214 conversion line and found that Employee #1's left arm was caught between the impression cylinder and rubber ink roller. The other worker shut down the main power of line 214 and the employees tried to release Employee #1's arm until the fire department arrived at the site with paramedics. Employee #1 was freed from the cylinders and had sustained a crushing injury to his left arm and fracture of his left hand. He was transported to Los Angeles County Harbor UCLA Medical Center, where he was hospitalized until April 17, 2007. The impression cylinder was 72 inches long and it was located 41 inches from the working platform of the conversion machine. The working platform was located 30.25 inches from the floor. The ink roller was in the "open" position during the cleaning procedure and there was one inch of space between the ink roller and the impression cylinder. After the accident, the employer found that the interlock switches on the 214 conversion line were loose and not working properly. The accident had happened because Employee #1 was cleaning the impression cylinder without stopping the machine although he had been trained on the employer's lockout/tagout procedures. Employee #1 had worked for the company for five months at the time of accident.