This cause is presented as a petition to review the findings and an award of the Industrial Accident Commission based upon the alleged “serious and wilful misconduct of the employer” wherein it was held that the injury to the applicant for industrial compensation resulted from the failure “to have in place a guard upon the machine upon which applicant was hurt at or near the point where she was required to handle its operation.” In addition to normal compensation an award of 50 per cent was imposed on the employer.
On or about July 14, 1944, Doris Tringale filed an application for adjustment of a claim, alleging that on March 7, 1944, arising out of and in the course of her employment an injury had occurred to the index and middle fingers of her right hand which resulted in their amputation. The application contained a general allegation of “wilful misconduct.” An amended application dated August 21, 1944, was filed just prior to the hearing by the referee alleging “serious and wilful misconduct of employer in directing applicant a wholly inexperienced person to work on a guardless punch machine. ’ ’ On January 10, 1945, the referee to whom the application had been assigned filed a report containing the following: “The controversy is whether the accident was caused by the serious and wilful misconduct of the employer. Almost immediately after it occurred, at least within 48 hours, an effective guard was installed at small cost. If it had been in place at the time, the accident would not have happened.
“No photographs are in the file. It is difficult to obtain a clear view unless one sees the machine in operation, which I did.
“As briefly as possible: Applicant was putting necks on canisters used in gas masks. The canister is a tin can open at one end with a small hole opening at the other where the neck goes on. The open end of the canister is put over a cylinder, which is upon a rod, all part of the machine. The rod is pulled out and then pushed back, when the canister is in place, under the press. The peddle is then tripped and the press, or plunger, with the neck comes down upon the canister and the neck is attached. The left hand is used to push the rod back and forth, the right to put the canister in place on the cylinder. This is the work applicant did. She claims she was adjusting the canister as it went back in place under the *667 press. She must have had her fingers on top of the can as it went under the plunger, because they were cut off.
“As long as the fingers are kept off the top of the can, there is no danger. Now that there is a guard, the fingers can’t get in under the plunger. A guard could have been in place at the time of the injury.
“The defendant says a guard was not required by ‘Mechanical Power Transmission Safety Orders’ of the Industrial Accident Commission, particularly Order 2601, the first paragraph of which reads: ‘These orders shall also apply to all connecting rods . . . revolving or reciprocating parts up to but not including the ‘ ‘ point of operation. ” ’ It is argued that by reason of this provision, the defendant is exempt from placing any guard at the point where the plunger contacted the horn of the cylinder. Just what is meant by the ‘point of operation’ is debatable. The witness Horswell, a Safety Engineer of the Commission, testified that in his opinion the ‘point of operation’ is the point where the operator stands and feeds objects into the machine. In accordance with this view no guard is necessary at the point where the injury is most likely to occur.
‘ ‘ To construe the point of operation as the point where the operator stands in front of the machine and feeds materials into it so as to make it unnecessary to guard moving parts in front of him would be to render Order #2601 inoperative. Rather I would be inclined to think the proper interpretation of the section would be to find a guard unnecessary only where materials could not be put into the machine, if at the point of operation, a guard was in place.
“Here it was entirely possible to put on a guard at small cost, which, when in place, would offer adequate protection and while in place would not interfere or hinder the work. Should the employer have realized this before the accident happened ?
“To work on this machine undeniably had a tendency to draw applicant’s fingers in and about the plunger where there was an open and obvious danger of serious injury. It was the kind of a danger, which, if the employer had turned his attention to it, he should have anticipated and corrected.
“If he did rely on the Safety Orders of the commission, he placed an erroneous interpretation upon them. The machine
*668 9 could have been guarded at small cost and the accident avoided.
“The employer should pay the applicant fifty per cent additional compensation and I so recommend.”
Considerable space is devoted by each side to the question whether there was a sufficient showing that
if
there was serious and wilful misconduct, it was the result of an act or the failure to act on the part of an “executive, managing officer or general superintendent.” In the present case there is sufficient evidence from which to draw a reasonable inference that the foreman had been invested with general discretionary powers as managing officer and superintendent, with particular supervisory authority in the care and operation of the machine and the direction of forty employees in that ‘ ‘ department” of the Simmons plant. Manifestly he was not “an employee occupying a relatively inferior and subservient position.”
(Bechtel etc. Corp.
v.
Industrial Acc. Com.,
No recommendation or allusion is made in the report of the referee with reference to the allegations in the amended application relative to the employer’s directing a wholly inexperienced applicant to work on a guardless punch machine.
Subsequent to the report of the referee, the commission on January 26, 1945, filed its findings and award and made a separate finding as follows: “Aforesaid injury was caused by the serious and wilful misconduct of the employer in that said employer failed to have in place a guard upon the machine upon which applicant was hurt at or near the point where she was required to handle its operation.” The finding is limited to the failure of the employer “to have in place a guard upon the machine, ’ ’ but there is no finding that the employer knowingly and wilfully violated any provision required by “ ‘Mechanical Power Transmission Safety Orders’ of the Industrial Accident Commission, particularly Order 2601.”
One of the safety inspectors for the commission testified that prior to the accident he had inspected the machine in question and did not then or at any other time recommend that a guard should be placed “on that machine.” Another safety engineer for the commission testified: “We have never *669 required guards on machines like that, and I have inspected hundreds of similar machines. ’ ’ The evidence shows that several months prior to the accident a security inspector representing a branch of the Security Command of the United States Government interested in the manufacture of “gas masks,” visited the Simmons plant and made certain recommendations for the “safety” of workers engaged in the manufacture of articles for the federal government, none of which required a guard on the machine in question. The only evidence upon which the finding of wilful misconduct may be based is the report of the referee who personally examined the machine after the accident.
In the absence of a specific order by the Industrial Accident Commission requiring a safety device, and in view of the opinions of safety engineers of the commission and of the United States Government that a safety device was not necessary, plus the report of the referee that the applicability of Order 2601 “is debatable,” was the commission justified, merely upon the referee’s observation of the operation of the machine after the accident, in finding that there was substantial evidence that the employer was guilty of wilful misconduct in failing to place a guard on the machine? The applicant for compensation is not quite clear in her description of how the accident occurred. She had been operating the machine for over an hour. Contrary to the report of the referee, there is evidence that with the guard now on the machine it is still possible for a similar accident to occur, but it would “not be as easy as it was before. ’ ’
Ordinarily engineers qualified by training and experience are proper witnesses within the purview of their training. Such testimony includes evidence as to instruments propelled by power or mechanical force. (10 Cal.Jur. 1011.) Whether a machine is of complicated construction, or its operation so simple that one educated in the law but untrained in the science of mechanical devices is able to say that a safety guard is necessary, are questions vital in the determination of this case. The members of the commission who did not examine the machine must have determined that the referee’s views, as expressed in the report, were superior to the opinions of the commission’s expert engineers.
The observations made by a referee in viewing the premises, or, as in this case, a mechanical device, may be con
*670
sidered by the commission as evidence.
(Ethel D. Co.
v.
Industrial Acc. Com.,
219
Cal. 699
[
commission is not bound by legally recognized rules of evidence but at least the evidence must have some degree of probative force. There is no evidence that the referee was an expert or knew anything about the construction or operation of this or any other mechanical device.
This is not a case where the trier of the facts may use his independent judgment against the opinion of one presumably skilled in subjects not within the knowledge of the ordinary person, and may determine a disputed question from observation. The facts here show, without contradiction, that the experts of the commission did not think, prior to the accident, that a guard was necessary. The referee’s opinion was formed as a sequence of the accident. The evidence shows that, with the guard, a similar accident would not be as likely to occur, but there is no evidence to show that, prior to the accident, anyone knew, or should have known, that such an accident would occur to an ordinarily prudent person. The referee’s report on this question is merely a surmise and conjecture which the law does not recognize as the basis of a finding. It is not substantial evidence.
(Thoreau
v.
Industrial Acc. Com.,
The views of the Supreme Court as set forth in the last three years are interesting. In
Parkhurst
v.
Industrial Acc. Com.,
In
Ethel D. Co.
v.
Industrial Acc. Com., supra,
inspectors employed by the commission had visited the premises involved
*672
and made recommendation of “various unspecified changes,” but did not make any recommendation with respect to a “ladder” from which the applicant in that ease had fallen and suffered injuries. It was stated that the evidence “with respect to the visits of inspectors is too vague to support so bold an argument” as that the commission had approved the use of the ladder without “handholds” which a specific safety order of the commission required. The court held (p. 708): “The Industrial Accident Commission, in its administrative capacity, possesses no authority to waive or consent to the violation of a duty owing primarily and directly to the employee from the employer.” In the present case there is no claim that the commission waived a duty to an employee by the failure of the inspectors to examine the machine, thereby approving its construction. On the contrary, this particular machine was examined, approved at that time and specifically' approved by safety inspectors as appears from testimony under oath before the referee. Ten years later upon facts somewhat similar to those in the Ethel D. Co. case and the present ease, in
Central Cal. Ice Co.
v.
Industrial Acc. Com.,
Extensive liberality has been exercised by appellate courts in construing and upholding findings made by the Industrial Accident Commission, but in view of the facts in this case and the holding in the Central Ice Company case it is impossible to approve the present finding of the commission that the failure to place a guard at the point where the applicant received the injury is wilful misconduct.
The second question presented concerns the duty of the commission in making an award to state its determination as to the rights of the parties and make findings upon all facts involved in the controversy. (Lab. Code, § 5800;
Western Metal Supply Co.
v.
Pillsbury,
*674 In the present petition in addition to the difference in the form of the finding from that in the Taylor case, supra, an issue was presented to the commission upon which neither the referee nor the commission made a finding, though it was referred to by the “rehearing referee” in his recommendation to deny a motion for rehearing. Just before the hearing started an amended application for adjustment of claim was filed in which the charges of serious and wilful misconduct were based upon the act of directing “a wholly inexperienced person to work on a guardless punch machine. ’ ’ A finding may be declared sufficient by reference to the record, including the evidence (Ethel D. Co. v. Industrial Acc. Com., supra), but in the present case there is no finding on the amended allegations of wilful misconduct based upon failure to instruct an inexperienced employee. It is “essential that findings be such that the truth or falsity of each material allegation in issue can be demonstrated from the findings.” (Taylor v. Industrial Acc. Com., supra, p. 81.) In a
rehearing before the commission there may appear substantial evidence from which a reasonable inference may be drawn that an inexperienced girl was directed to operate a mechanical instrument, and it is possible, depending upon circumstances, that the evidence may show such disregard of probable or possible consequences as to warrant a finding of serious and wilful misconduct on that issue. The rehearing referee reported on this subject. His theory may or may not be sound. On this writ of review it is impossible to pass on that question.
The award of additional benefits based upon the alleged serious and wilful misconduct of the petitioning employer’s failure to “place a guard upon the machine” etc. is annulled. In view of the failure of the commission to find on the issue presented in the amended application for compensation, the cause is remanded to make such finding as may seem proper to the commission.
Peters, P. J., and Knight, J., concurred.
Respondents’ petition for a hearing by the Supreme Court was denied November 1, 1945.
