A worker suffered a traumatic amputation when a point-of-operation hazard on a die-cutting press was activated while the worker's hand was within the danger zone. The two-hand control device — a safety device designed to require both hands to be on controls before the press could cycle — had been defeated by securing it in the activated position with a tie-wrap.
What Happened
- The two-hand control device on the die-cutting press had been bypassed using a tie-wrap to hold it in the activated position
- The bypass allowed the press to cycle without requiring both hands on the controls
- No regular audit or inspection of safety device functionality had been conducted
- Workers had not been instructed that defeating safety devices was prohibited
- The employer had no formal procedure for verifying safety device integrity before each shift
The Outcome
Flexo Products Ltd. was convicted under the OHSA and O. Reg. 851 for failing to maintain the safety device on the die-cutting press in an effective condition. The company was fined $90,000 plus the victim fine surcharge.
Citation: 2015 ONCJ 280 · Penalty: $90,000
What This Case Teaches Ontario Industrial Employers
Safety devices must never be defeated, bypassed, or modified — and employers must audit equipment regularly to confirm that controls remain functional and unmodified. A pre-shift verification requirement for safety device integrity is a foundational element of an adequate machine safety program. Where a device has been bypassed, the pressing question is why — and that question must be answered before production resumes.
This summary is drawn from the reported outcome of an Ontario occupational health and safety prosecution. It is provided for educational purposes and is not legal advice.