Abstract: At 6:30 p.m. on December 4, 2003, Employee #1, a baler operator from the Weyerhaeuser Incorporated in Norwalk, California, was standing on a portable 6-ft A-frame ladder inside the recycling facility near a baler and its wire feeder unit. Employee #1 was clearing a loop from one of the moving wires with his left hand. His thumb got pulled into the loop near a top metal bracket of wire-feeder and was amputated. Employee #1 was taken to a local medical center for treatment, but his thumb could not be reattached. Investigations revealed that the existing guard, a yellow mesh cover on the wire feeder, was inadequate and did not cover the pinch points near the top brackets and the bottom roll of machine, as required by regulation.