Abstract: On August 30, 2011, Employee #1, a tool and die maker, was assigned to set up dies on the Bliss #5 power-operated punch press to start production of 1.5-inch square nuts. The employer had not established die setting procedures for the Bliss #5 Power-operated punch press. Employee #1 was making adjustments to the bottom die (shoe) by tightening and loosening screws to obtain proper gauge on the Bliss #5, while it was powered on. As he tightened the last screw on the bottom die (shoe), he used so much force that he became unbalanced and inadvertently activated the foot device with his right foot, causing the upper die (ram) to move down towards the bottom die. When the Bliss #5 was triggered, Employee #1's right hand was in the point of operation, between both dies. His right middle finger was crushed, and his right fourth finger was amputated. He was transported to a nearby hospital by ambulance, where he was hospitalized for two days.