Abstract: At 11:30 p.m. on December 13, 2013, an employee was removing an obstruction ("the choke") from large rollers at the bottom of a chute inside the mill housing of a sugarcane crusher. While monitoring the operation of a sugarcane crusher, which uses large rollers to extract liquid from raw sugarcane for subsequent refining into sugar and molasses, the machine became clogged as a result of an obstruction. Without implementing any lockout/tagout procedures, the employee entered a chute of the machine through a small window, measuring 24 inches by 14 inches, to remove the obstruction. Obstructions were typically removed from the machines large rollers by using tools/equipment such as a pry bar, chisel, sledge hammer, jack hammer, potato rake, and pressure washer, but workers always were required to enter the chute to accomplish this task. As the employee was inside the chute, a coworker manually opened the turbine steam valve that causes the rollers to turn. The employee was crushed by the machines rollers before he could escape through the chute opening. The employee was killed.