Background: Over the past few decades, hundreds of manufacturing workers have suffered fatal injuries while performing maintenance and servicing on machinery and equipment. Using lockout/tagout procedures could have prevented many of these deaths. Methods A narrative text analysis of OSHA accident investigation report summaries was conducted to describe the circumstances of lockout/tagout-related fatalities occurring in the US manufacturing industry from 1984 to 1997. Results The most common mechanisms of injury were being caught in or between parts of equipment, electrocution, and being struck by or against objects. Typical scenarios included cleaning a mixer or blender, cleaning a conveyor, and installing or disassembling electrical equipment. Lockout procedures were not even attempted in the majority (at least 58.8%) of fatal incidents reviewed. Conclusions Lockout/tagout-related fatalities occur under a wide range of circumstances. Enhanced training and equipment designs that facilitate lockout and minimize worker contact with machine parts may prevent many lockout/tagout-related injuries.