DS Smith Paper failed to act on 73 urgent recommendations in a specialist safety report compiled 11 months before operations director John Stoddard was killed at its Higher Kings plant at Cullompton, Devon – “a failure at the highest level of the company,” Judge Francis Gilbert QC said.

Malcolm Galloway, prosecuting for the HSE at Exeter Crown Court yesterday, said Stoddard had climbed onto a walkway and was smoothing out a production line when his hand became trapped and he was flipped into the machine on 24 September 2011.

There was no guard on the machinery and he was flung into the air and pulled into a set of rollers after his hand became trapped in a device called an incoming nip.

Stoddard, a 41-year-old father of two who lived locally, died instantly in the accident. He had worked at the plant for 23 years. 

Galloway said some of the concerns raised in the safety report were categorised as very high risk – needing attention within a day – and high risk – needing fixing within a week. 

The HSE investigation said 73 recommendations had not been carried out, including 33 that should have been addressed within 24 hours. Many of the recommendations called for improved guards to prevent access to moving machinery.

DS Smith admitted failing to ensure safe working and was fined £400,000, with £34,761.67 costs, by Judge Gilbert. 

Gilbert said the company’s failure to act on the safety report’s recommendations was “a serious aggravating feature” and many had not been rectified 11 months later when the accident occurred. A second internal report had identified the area as hazardous, he said.

Suitable guarding was installed shortly after the accident. 

Gilbert stated: “If the company had corrected the hazardous feature…this fatality would not have occurred. 

“The Health and Safety Executive concluded that the risk to operators from this moving machinery was obvious. They say the failure to address so many areas of high or very high risk was a failure at the highest level of the company. 

“That is disputed by the company but it seems to me there was little, if any investigation by the company at board level to ensure the recommendations were carried out.” 

As Stoddard’s family listened from the public gallery, Simon Antrobus, defending, offered an apology on behalf of chief executive Miles Roberts and the company. 

He said: “Mr Roberts wishes me to express an unreserved apology to the family for the loss of someone who was clearly a conscientious, long standing and well respected employee and member of management. 

“The company is concerned that the family should leave court believing they have not even said sorry. That is not the case here. The company accept responsibility in full.”

£4bn-turnover DS Smith ran the former St Regis Paper Mill at the time but the accident happened after they had agreed to sell it for £4.6m to an Asian conglomerate. Stoddard died six days before the handover.

Simon Antrobus, defending, accepted the hazard should have been foreseen. 

He said the company has renewed its commitment to safety and there had been no accidents in the past year at any of its plants. 

“Mr Stoddard was held in considerable regard for his conscientious approach towards safety and had a very strict zero tolerance approach towards it. We want his family to hear that. 

“It fits with their own experience of him at home and there is no suggestion of blame or that he was the author of his own misfortune.” 

HSE Inspector, Simon Jones, speaking after the hearing, said that a proper risk assessment would have established safe practices.

“DS Smith’s failure to guard a dangerous piece of moving machinery tragically cost Mr Stoddard his life and has left his family without a husband, father and brother.

“Potentially dangerous machinery should always be guarded and turned off when workers need access to repair faults."

Further information about guarding machinery can be found on the HSE website at http://www.hse.gov.uk/fee-for-intervention/basic-safety-mistakes/guards.htm.