Abstract: At approximately 5:30 p.m. on July 17, 2006, Employee #1 was working on a single-stroke 110-ton capacity, punch press (machine Number 9, Serial Number 9-6609), forming some metal pieces under the die, and as he put his left hand in point of operation area to remove a formed metal part, the machine activated, the ram came down and crushed his hand. Employee #1 stated that the machine activated by itself without pressing the two-hand controls. The employer indicated that Employee #1 leaned against the controls while removing a formed metal piece from under the die of machine. Investigations revealed that the two-hand controls on mechanical punch press were located very close to each other, only 7.5-in. apart, and were not housed in pockets to prevent them from unintended operation. Employee #1 suffered a full amputation to two fingers of his left hand and was hospitalized for four days for medical treatment.