Man crushed to death in 3 seconds after getting trapped in cake-making machine


Louis Michael Standen from Burnley was killed in December 2019 while working at food packaging manufacturer, Doric FPD, in Burnley – on the day he died he said he should not be operating the Horauf machine because he wasn’t fully qualified

Louis Michael Standen
Louis Michael Standen was crushed to death while working at a factory in Burnley

A factory worker was crushed to death in three seconds when a machine closed on top of him.

Louis Michael Standen was killed on Tuesday, December 3 2019 when he was working at food packaging manufacturer, Doric FPD on Farington Road in Burnley.

Louis was at the end of his shift operating a Horauf cake board-making machine when he dropped an item inside the machine, an inquest has heard.

When the 27-year-old reached underneath the machine to retrieve the item he became trapped as the machine lowered on top of his head and chest, reports Lancashire Live.

During the second day of the two-day inquest the jury heard from Sharon Butler, an inspector with the Health and Safety Executive, who carried out an investigation following the death of Louis.

“On December 4 I got a call at 7am to say there had been a fatal accident and I was asked to attend as soon as I could,” Miss Butler said.

He was killed at the factory on Farrington Road in Burnley



“I contacted a mechanical engineer to attend with me and we arrived on site at 9am.”

When Miss Butler and the engineer attended the factory Louis’ body was still trapped underneath the machine.)

Miss Butler described how the machine operates and referred to the two minute and 21 second time window when the Horauf is switched off after which the glue trough, which crushed Louis, lowers, leaving a gap of just 7.5 cm. The air supply had been switched off just before Louis reached under the machine to retrieve the item he had dropped.

“When the power is cut off, and the air supply is stopped, it’s fed by a compressor situated in the woodshop. It took two minutes and 21 seconds for the air supply to be lost to the glue trough which then lowers over a three-second period,” she explained.

“It would seem the glue trough lowered and that’s what caused the injuries to Louis,” Miss Butler added.

The inquest earlier heard that Louis, a former Burnley College student, had told a colleague on the day he died that he should not be operating the Horauf machine because he wasn’t fully qualified.

However, Miss Butler examined Doric’s training records as part of her investigation, which showed that Louis had signed documents to confirm he had undertaken safe systems of work training.

She also confirmed that there was nothing in the safe systems of work documentation which referred to the time taken for the air supply to be cut off to the machine or the three-second period during which the glue trough lowers.

Louis was at the end of his shift operating a Horauf cake board-making machine at the Doric FPD factory



“The hard bit was we had such a small window during which the accident could have happened, it’s just one of those accidents where you look at it and think it’s an unfortunate event,” Miss Butler added.

“The risk of entrapment was just three seconds.”

Other witnesses, who gave evidence during the first day of the inquest, also confirmed Louis had been properly trained.

Angelina Grzechowiak, who suffered an accident when her wrist was trapped under the same machine seven weeks before Louis’ death, said she had been one of those who had trained Louis and confirmed he had been shown to use a magnetic picker or a littler picker to retrieve any items dropped within the workings of the machine.

A report by Sheldon Taylor, the mechanical engineer who visited Doric with Miss Butler, was read out during the inquest.

“The glue trough represented a trapping hazard… The hazard would not have been obvious prior to the incident,” Mr Taylor said in his report.

Returning a conclusion of misadventure, which relates to a deliberate act being undertaken with unintended consequences, the foreman of the jury said: “Louis Michael Standen died on December 3, 2019, asphyxiation caused by external compression of the chest and neck.

“We believe Mr Louis Standen went under the machine to retrieve a dropped article when the air pressure was turned off it took 2min 21s as a consequence of the pressure dropping the glue trough dropped moving the trough to 7.5cm gap within a three second period.

“Mr Louis Standen had asked if the air pressure could be turned off and we conclude he said it could. The loss of pressure caused the glue trough to fall resulting in Louis Standen being trapped. We unanimously agree that Louis Standen’s death was a result of misadventure.”

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George Holan

George Holan is chief editor at Plainsmen Post and has articles published in many notable publications in the last decade.

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