DOLI 6
Summary of
Page 1 of 18
Evidence
Where Evidence
Recorded & How
Element Proved
Facts
Zion Wildlife Services Ltd (ZWS) is a limited liability company having its
DOLI 11/29
registered office at Zion Wildlife Gardens Ltd (ZWG) Gray Road, R D 1
Kamo, Whangarei. The nature of the business operated by ZWS appears
to be that of a supplier of labour to ZWG.
ACT 1982
ZWG is a limited liability company having its registered office at Gray
DOLI 11/29
Road, R D 1 Kamo, Whangarei. The nature of the business operated by
ZWG is that of a zoo where paying visitors come to view and, prior to 28
May 2009, in some cases interact with some of the lions and tigers and
other animals on-site. ZWG in relation to ZWS were operating as either
the
person in control of
the place of work that makes up the operations
at Gray Road, or as a
principal to ZWS having engaged them as a
contractor to supply ZWS
employees to undertake work required to
operate the ZWG facility.
DOLI 11/29
Country Developments Ltd (CDL) is a limited liability company having its
registered office at Zion Wildlife Gardens Ltd (ZWG) Gray Road, R D 1
INFORMATION
Kamo, Whangarei. The nature of the business operated by CDL is that of
landowner / developer and ZWG apparently leases the property at Gray
Road from CDL.
DOLI 11/29
On 27 May 2009 Patricia Elaine Busch (Mrs P Busch) was the Managing
Director ZWS, ZWG and CDL. She was the sole shareholder for ZWS and
CDL. She also held a 25% shareholding in ZWG.
DOLI 11/20
ZWG operates under the Ministry of Agriculture and Forestry (MAF)
Biosecurity New Zealand (MAFBNZ) Standard 154.03.04 Containment
Facilities for Zoo Animals (Zoo Standard). The Zoo Standard is approved
by the Environmental Risk Management Authority (ERMA) under the
Hazardous Substances and New Organisms Act 1996 and by MAF
pursuant to Sections 39 and 40 of the Biosecurity Act 1993.
DOLI 11/20
The Zoo Standard requires a facility such as ZWG to have approval from
MAF to operate and to meet the requirements it and the Zoo Standard
imposes. MAF also subjects facilities such as ZWG to regular audits and
inspections by MAFBNZ Inspectors. Documents received from MAFBNZ
indicate that they were undertaking audits and inspections on a regular
basis of the ZWG site and operations.
Clifford Dalu Mncube (Mr Mncube) was on 27 May 2009 an
employee of
DOLI 11/23 Mncube IEA
ZWS. ZWS
employed Mr Mncube in the position of animal handler and
wildlife sanctuary assistant. Part of Mr Mncube’s role was to plan activities
and work with the big cats on a day-to-day basis around the interaction
RELEASED UNDER THE OFFICIAL
and group tours. Mr Mncube had commenced employment with ZWG in
2005 and on 29 June 2007 his employer was changed from ZWG to ZWS
under the same employment terms and conditions.
DOLI 6 – Summary of Evidence – Version 1.1 – o1/2006
Element to prove is indicated in
bold type
Page 2 of 18
Where Evidence
Recorded & How
Element Proved
Facts (cont.)
On 27 May 2009 Mr Mncube was also responsible for providing training
DOLI 09 Hol and
and day to day leadership for other employees of ZWS involved in animal
handling under instruction from Glen James Holland (Mr Hol and) and Mrs
Busch.
Napoleon Marthinus Ferreira (Mr Ferreira) who is generally known on site
DOLI 11/23 Ferreira IEA
as Martin was on 27 May 2009 an
employee of ZWS. ZWS
employed Mr
DOLI 9 Ferreira
Ferreira in the position of animal handler and wildlife sanctuary assistant
and in his day to day work he was expected to conduct tours, clean
ACT 1982
enclosures.
9(2)(a)
who is generally known on site as 9(2)
DOLI 11/23 9(2)(a)
was on 27 May 2009 an
employee of ZWS. ZWS
employed
(a)
9(2)(a)
in
DOLI 9 9(2)
the position of building assistant with duties that involved erecting and
(a)
maintaining buildings, tracks and other facilities within the ZWG site.
9(2)(a)
was on 27 May 2009 an
employee of ZWS. ZWS
employed 9(2)(a)
in the position of
DOLI 11/23 9(2)(a)
animal handler and wildlife sanctuary assistant including truck driving with
IEA
DOLI 9 9(2)(a)
duties which included conducting group tours and assisting as required in
other areas. In addition to his paid employment with ZWS INFORMATION
9(2)(a)
was also a volunteer at ZWG on some days each week.
9(2)(a)
was on 27 May
DOLI 11/23
2009 an
9(2)(a)
employee of ZWS. ZWS
employed 9(2)(a)
in the
9(2)(a) IEA
position of joint office manager, retail and tours with duties associated
DOLI 9 9(2)(a)
running the retail shop/office.
9(2)(a)
was on 27 May 2009 an
employee of ZWS. ZWS
employed 9(2)(a)
in the position of wildlife sanctuary assistant with
DOLI 11/23 9(2) IEA
duties that involve assisting with office administration work, some
DOLI 9
(a)
9(2)
marketing, etc.
(a)
9(2)(a)
who is generally known on site as 9(2)
was on 27 May 2009 an
employee of ZWS although he was on leave an
(a) d
DOLI 11/23 9(2)(a) IEA
in South Africa on this date. ZWS
employed 9(2)(a)
in the position
DOLI 9 9(2)(a)
of animal handler and wildlife sanctuary assistant with duties that included
assisting with animal encounters, cleaning and maintenance.
ZWG was on 27 May 2009 the
principal to a
self employed contractor
Mr Holland who was trading as Wildlife Connections and who had been
DOLI 11/7 ZWG & Hol and
engaged to provide advice and information and to fulfil the Licensed
Contract
DOLI 9 Hol and
Operator role under MAFBNZ rules. There was a formal contract
document between the parties for this work and Mr Holland had authority
to speak on behalf of ZWG in his role as the “Operator”.
DOLI 11/7 ZWG, ZWS &
ZWS, ZWG and CDL were on 27 May 2009 the
principals to a
self-
CDL /
RELEASED UNDER THE OFFICIAL
9(2)
Contract
employed contractor 9(2)(a)
who is
DOLI 9
(a)
9(2)
commonly known as 9(2)(a)
had been engaged by the
(a)
companies to fulfil the role of Operations Manager for Staffing and
Security at the ZWG site.
DOLI 6 – Summary of Evidence – Version 1 – o9/2004
Element to prove is indicated in
bold type
Page 3 of 18
Where Evidence
Recorded & How
Element Proved
Facts (cont.)
9(2)(a)
was on 27 May 2009 resident
DOLI 9 9(2)(a)
at the ZWG site. 9(2)(a)
is the daughter of 9(2)(a)
9(2)(a) undertakes some work around the ZWG site and has previously
been involved with raising cubs.
9(2)(a)
a friend of 9(2)(a)
was
DOLI 11/21 Police
staying at the ZWG site on 27 May 2009 and assisting with tours and
Statement by 9(2)
basic animal care.
(a)
ACT 1982
On 27 May 2009, approximately 42 wild animals were held in physical
containment at the park, consisting of lions, tigers, cheetahs, servals, a
black leopard and a baboon. These animals are under the care of ZWG
for their upkeep and welfare, with such work actually being undertaken by
employees of ZWS. CDL provides the facilities and containment for the
wild animals.
Amongst these wild animals were two (2) white Bengal tigers, a male
called Abu and a female called Rewa. According to the records of ZWG
Abu was born 13 June 2001 and acquired 10 January 2002 from the
Wildwood Endangered Animal Sanctuary in Oregon, USA, arriving in New
Zealand on 4 June 2002. These two tigers, Abu and Rewa, were not
INFORMATION
animals that were used for interactions with the public.
On 18 February 2009 Abu attacked ZWS employee Demetri Nicholas
Reference Enclosure 9
Price (Mr Price) while the tiger was being relocated along with the female
somehow
Rewa from another enclosure into Enclosure 9. This attack resulted in
serious harm to Mr Price. This Department was stil investigating this
event on 27 May 2009. Mr Mncube was also involved in this incident and
was hailed as a hero for getting Abu off Mr Price during the attack.
On 26 May 2009 an adjourned Employment Authority hearing into a claim
by Craig Busch (Mr Busch) for unjustified dismissal was reconvened at
the D
epartment of Labour’s Whangarei offices with Authority Member
Yvonne Oldfield (The Authority) presiding. This hearing was taking
evidence from a number of the employees of ZWS and contractors to
ZWS and ZWG. It was set down for three days.
On the morning of 27 May 2009 most employees of ZWS arrived on site
at their usual starting times of between 0800 and 0830. Mr Holland was
DOLI 9 Ferreira, 9(2)
also present at this time as there was a booked ‘big cat encounter’.
9(2)(a)
(a)
MAFBNZ had previously placed a requirement on ZWG to ensure that the
9(2)(a)
MAF Approved Operator be present for all big cat interactions with the
public.
Two English tourists, 9(2)(a)
9(2)(a)
had booked a ‘big cat encounter’ for the
DOLI 11/21 Police
Statements by 9(2) &
morning of 27 May 2009. 9(2)(a)
and 9(2)(a)
arrived at the retail
RELEASED UNDER THE OFFICIAL
9(2)(a)
shop from Dargavil e at approximately 0845 and were about 15 minutes
DOLI 09
(a)
9(2)(a)
late. 9(2)(a)
contacted Mr Hol and by radio to let him know
that these ladies had arrived. In addition she radioed Mr Mncube to
prepare the cat for the interactive.
DOLI 6 – Summary of Evidence – Version 1 – o9/2004
Element to prove is indicated in
bold type
Page 4 of 18
Where Evidence
Recorded & How
Element Proved
Facts (cont.)
While waiting for Mr Holland to arrive to take 9(2)(a)
and 9(2)(a)
up for their ‘big cat encounter’ three more visitors “walked in” seeking a
DOLI 11/21 9(2)(a)
guided tour. These were 9(2)(a)
her
9(2)(a)
daughter 9(2)(a)
from England and their taxi
driver 9(2)(a)
DOLI 9
9(2)(a)
Mr Holland invited the 9(2)(a)
and 9(2)(a)
to go with him to
observe the ‘big cat encounter’ 9(2)(a)
and 9(2)(a)
were about to
DOLI 11/21 9(2)(a)
take part in then join a guided tour.
9(2)(a)
ACT 1982
9(2)(a)
placed signs at the door to the retail shop and at the
gate stating ‘Cat Interaction or Encounter taking place, no-one beyond
DOLI 9 9(2)(a)
this point’. Mr Ferreira was given a lead by Mr Mncube and went to collect
a young lion Sabili from its enclosure for the encounter. The interactive
DOLI 09 Ferreira
lion encounter itself lasted about 20 to 25 minutes and involved 9(2)(a)
DOLI 9 9(2)
DOLI 11/21 Police
and 9(2)(a)
being able to pat the lion and pose for photographs
Statements
(a) 9(2)(a)
with it.
9(2)(a)
With the ‘big cat encounter’ was completed Mr Mncube at about 9.20 a.m.
called 9(2)(a)
on the radio to come and take 9(2)(a)
and 9(2
DOLI 9 9(2)(a)
INFORMATION
9(2)(a)
on the guided tour. Mr Mncube took the lion on its lead to pu)t it
back in its enclosure. As he walked the lion through the pathway behind
(a)
Enclosures 10 and 11 he noticed that the lion wanted to play with the low-
hanging branches of a tree overhanging the pathway.
DOLI 9 9(2)
(a)
Once the lion was locked back in its enclosure Mr Mncube notified 9(2
9(2)(a)
that the Park could reopen. Mr Mncube handed 9(2)(a) )
DOLI 9 9(2)(a)
and 9(2)(a)
over to 9(2)(a)
when he arrived, took them
(a)
DOLI 11/21
along with the 9(2)(a)
and 9(2)(a)
on a guided tour
9(2)(a)
9(2)(a)
through the rest of the ZWG site starting near Enclosures 17.
While 9(2)(a)
was taking the visitors on the guided tour Messrs
Mncube and Ferreira agreed that it was close enough to smoko so they
DOLI 9 9(2)(a)
DOLI 9 Ferreira
stopped for their morning tea break in the Barn. They were joined at their
break by 9(2)(a) who recal ed that this was about 10 o’clock.
DOLI 9 Ferreira
During the break they discussed the ongoing Employment Authority
DOLI 9 9(2)
Hearing as well as other matters. Mr Mncube talked with 9(2)(a)
the
(a)
issue of the low hanging tree branches and asked 9(2)(a) to have a look
at them with him after the break.
DOLI 9 9(2)
(a)
After the break Messrs 9(2) and Mncube went down to the area behind
Enclosures 10 and 11 to l
(a) ook at the low hanging branches. After a brief
discussion it was agreed that 9(2)(a) would trim the branches back so
that they did not hang down and distract the lions when being walked
through that area.
DOLI 9 9(2)
(a)
RELEASED UNDER THE OFFICIAL
After the discussions 9(2)(a)
went and got the chainsaw and the
required PPE (chainsaw chaps, helmet and hearing protection) and put
DOLI 9 9(2)
them on the 1-tonne dumper known on site as the Maggot.
(a)
DOLI 6 – Summary of Evidence – Version 1 – o9/2004
Element to prove is indicated in
bold type
Page 5 of 18
Where Evidence
Recorded & How
Element Proved
Facts (cont.)
Mr Mncube then caught up with Mr Ferreira to start the cleaning of the
DOLI 9 Ferreira
enclosures. They were accompanied by 9(2)(a)
who came along with
them observing from the outside and taking photos now and then. 9(2
DOLI 11/21 Police
9(2)(a) stated that she joined them at about 10.30 a.m. They started
) at
Statement by 9(2)
Enclosure 5 or 6.
(a)
(a)
The cleaning work consisted of picking up all the bones and faeces on the
DOLI 9 Ferreira
ground in the enclosures. The tools used by Messrs Mncube and Ferreira
to do this consisted of a wheelbarrow, a shovel, and a stick to flick the
ACT 1982
bones or faeces onto the shovel then into the wheelbarrow. 9(2)(a)
DOLI 11/21 Police
Statement by 9(2)
observed that on entering each enclosure Messrs Mncube and Ferreira
were interacting with the animals including patting and cuddling them.
(a)
At about 10.30 a.m. a New Caledonian family consisting of mother, father
and two boys came into the retail shop. 9(2)(a)
said that as
DOLI 9 9(2)(a)
they were French speakers with very limited English and that it took a little
while to establish what they wanted.
9(2)(a)
radioed Mr Mncube and informed that she had an 11
DOLI 9 9(2)(a)
o’clock tour due and asked if he had someone who could come down to
take it. Mr Mncube said that he would come down and that he would be
INFORMATION
there in 5 minutes.
Mr Mncube arrived at the retail shop at about 10.45 a.m. and told 9(2
DOLI 9 9(2)(a)
9(2)(a)
that he would take the New Caledonian family and hand
)
them over to 9(2)(a)
who was up the top by Enclosures 5 and 6
(a)
with the earlier tour group.
After cleaning several enclosures Mr Ferreira stated that Mr Mncube
DOLI 9 Ferreira
changed the routine by saying that instead of cleaning Enclosure 2 next
with the three young tigers in, that they go and clean Enclosure 9
containing Abu, a male white tiger and Rewa, a female white tiger.
Enclosure 9 was a large, sloping enclosure on the northern side of the
DOLI 11/21 Police scale
small stream running through the ZWG site. The enclosure could be
drawings
entered through a large steel frame gate and included a separate den box
into which animals in it could be secured.
By this time 9(2)(a)
and the tour group were at Enclosure 9 where
DOLI 9 9(2)(a)
they observed the male tiger Abu in the den and that they spent a few
minutes watching the female tiger Rewa in the main enclosure. This was
the last stop on the guided tour and 9(2)(a)
then took the group
back up from Enclosure 9 so they could return to the gift shop.
When they arrived at Enclosure 9 Mr Mncube unlocked it and Messrs
DOLI 9 Ferreira
Mncube and Ferreira went into the animal enclosure. Mr Ferreira stated
DOLI 11/21 Police
that he was pushing the wheelbarrow and that Mr Mncube had the spade
Statement by
RELEASED UNDER THE OFFICIAL
9(2)
and stick. They only opened the gate enough to get themselves and the
(a)
wheelbarrow through. 9(2)(a)
recal s that Mr Ferreira was pushing the
wheelbarrow but could not recal if Mr Mncube was carrying anything.
DOLI 6 – Summary of Evidence – Version 1 – o9/2004
Element to prove is indicated in
bold type
Page 6 of 18
Where Evidence
Recorded & How
Element Proved
Facts (cont.)
Mr Ferreira stated that the female tiger Rewa came up to him as she was
DOLI 9 Ferreira
very friendly. He stated that the Abu appeared to be sleeping or lying in
the den when they first entered the enclosure. 9(2)(a)
stated that Abu
DOLI 11/21 Police
was in the den when Messrs Mncube and Ferreira entered the enclosure.
Statement by 9(2)
(a)
9(2)(a)
when he saw Messrs Mncube and Ferreira entering
DOLI 9 9(2)(a)
Enclosure 9 he stopped the tour group and said to them “oh there he is,
there’s Abu, the biggest white tiger we’ve got” as he saw Abu emerge
ACT 1982
from the den.
9(2)(a)
stated that the male tiger Abu was looking out from inside the
DOLI 11/21 Police
den and walked straight out to Mr Mncube. She stated that the tiger was
Statement by 9(2)
not making any sounds and to her did not look like he was in attack mode
(a)
or anything.
Mr Ferreira was about 2 metres from Mr Mncube when he saw Abu come
DOLI 9 Ferreira
out of the den and go towards Mr Mncube. He said that he heard Mr
Mncube greet Abu with a ‘hel o’. Mr Ferreira said that he could see the
tigers face and that things didn’t look right.
INFORMATION
Mr Ferreira said that before he could warn Mr Mncube about Abu not
DOLI 9 Ferreira
looking right that it (the tiger) had grabbed the upper leg of Mr Mncube.
9(2)(a)
stated that the tiger grabbed Mr Mncube by the leg with his
DOLI 11/21 Police
Statement by 9(2)
mouth she remembers that it was around the knee area.
(a)
About this time 9(2)(a)
who had been focussed on talking to the
DOLI 9 9(2)(a)
tour group caught movement out of the corner of his eye and saw that the
tiger appeared to be up against Mr Mncube
Mr Ferreira stated that Mr Mncube appeared very calm and said to him
DOLI 9 Ferreira
“Martin, help me please”. Mr Ferreira started hitting the tiger on the nose
area with the stick. 9(2)(a)
said she moved further along the side of
DOLI 11/21 Police
Statement by 9(2)
the fence and felt shocked and helpless.
(a)
9(2)(a)
stated that he could not hear any growling noise or
DOLI 9 9(2)(a)
snarling from the tiger. He stated that he saw Mr Mncube punch the tiger.
He stated that he heard Mr Mncube say “help me Martin, I’m in trouble”.
He then directed that his tour group stay where they were and ran back
down the pathway to Enclosure 9 where the attack was occurring.
The tiger then started growling and tried to drag Mr Mncube into the den.
DOLI 11 Ferreira
Mr Ferreira said that Mr Mncube grabbed hold of the rail running across
DOLI 10 Photo Exhibit
the top of the doorway into the den to keep from being dragged in. Mr
NTH/498/0019
Ferreira states that Mr Mncube was stil very calm and that he looked at
him and said “this is serious mate, just please help me”
DOLI 9 Ferreira
RELEASED UNDER THE OFFICIAL
9(2)(a)
said that only Mr Mncube’s legs were sticking out of the den
and that Mr Ferreira was stil trying to hit the tiger about the head with the
DOLI 11/21 Police
stick. 9(2)(a)
said that when he arrived at the enclosure gate that
Statement by 9(2)
Mr Mncube was being dragged by his left shoulder into the den.
DOLI 9
(a)
9(2)(a)
DOLI 6 – Summary of Evidence – Version 1 – o9/2004
Element to prove is indicated in
bold type
Page 7 of 18
Where Evidence
Recorded & How
Element Proved
Facts (cont.)
Mr Wickenden took the CO2 fire extinguisher from its box at the corner
DOLI 9 9(2)(a)
&
Ferreira
just above the main gate to the enclosure. As the tiger had partially
DOLI 10 Photo Exhibit
dragged Mr Mncube into the den 9(2)(a)
then fired a blast of the
NTH/489/0013
fire extinguisher through the peep hole in the door.
DOLI 10 Photo Exhibit
NTH/489/0020
Both Messrs 9(2)(a)
and Ferreira said when interviewed that they had
been concerned that the fire extinguisher could cause harm to Mr Mncube
DOLI 9 9(2)(a)
&
so the blasts from it were short ones.
Ferreira
ACT 1982
While this was going on Mr Ferreira was stil trying to hit the tiger but with
DOLI 9 9(2)(a)
&
little success as it was inside the den and there was limited effect from the
Ferreira
hitting due to the height of the animal entrance (1.11 metres).
DOLI 11/3
9(2)(a)
then tried to throw the fire extinguisher over the fence to
DOLI 9 9(2)(a)
&
Mr Ferreira but as the extinguisher weighed about 3.5 kg and the fence
Ferreira
was 3 to 3.5 metres high he was unable to do so. A decision was made
by Messrs Ferreira and 9(2)(a)
that they would briefly open the gate,
hand the fire extinguisher in and close the gate again which they did.
At
INFORMATION
about this time 9(2)(a)
used his radio to call “Code Red, Code
Red, Code Red – Abu and Dalu”. This alerted all staff within the park with
DOLI 9 9(2)(a)
&
radio’s that there was a major emergency taking place and where.
9(2)(a)
9(2)(a)
who had been working with the chainsaw clearing the low
hanging branches behind Enclosures 10 and 11 wearing hearing
DOLI 9 9(2)
protection and the other PPE heard 9(2)(a)
calling “Dalu, Dalu” as
(a)
he finished the work was putting the chainsaw down and taking off the
helmet and hearing protection.
Mr Ward said he looked in the direction the voices had come from and
could see what looked like a mass of bodies moving very quickly from his
DOLI 9 9(2)
right to left towards the den. He heard Mr Ferreira calling for the prodder
(a)
(cattle prodder).
9(2)(a)
said he took off to get the prodder from the ‘Tardis’, a small
round shed outside the Barn. He said that he was stil wearing the
DOLI 9 9(2)
chainsaw chaps while running and started reaching down to take them off
(a)
as he ran as they were hindering his movements. At the same time 9(
9(2)(a)
ran across to Enclosure 12 to get another fire extinguisher.
DOLI 9
2)
9(2)(a)
(a)
9(2)(a)
who had realised that the tour group 9(2)(a)
had been
DOLI 11/21 Police
leading was stil watching went to them and started escorting them away
Statement by 9(2)
from Enclosure towards the barn and the main gates.
(a)
The tiger had now come out of the lockup or den box and started to drag
DOLI 9 Ferreira
Mr Mncube down the fenceline. 9(2)(a)
was spraying the tiger in the
RELEASED UNDER THE OFFICIAL
face with the fire extinguisher but to no avail; it would not release Mr
Mncube.
DOLI 6 – Summary of Evidence – Version 1 – o9/2004
Element to prove is indicated in
bold type
Page 8 of 18
Where Evidence
Recorded & How
Element Proved
Facts (cont.)
The tiger continued to drag Mr Mncube down the fenceline and about this
DOLI 9 9(2)
time 9(2)(a) arrived with the cattle prodder. As he had run back from the
(a)
‘Tardis’ to Enclosure 9 along the pathway above Enclosures 7 and 8 he
had to run around the end of Enclosure 9 to get to the lower side of it
where Mr Mncube and the tiger were up against the fence.
9(2)(a)
was able to get the cattle prodder through the fence and pushed
DOLI 9 9(2) & Ferreira
into the face of the tiger. He stated that the tiger seemed to just absorb
(a)
the shock for perhaps three to four seconds before it released Mr Mncube
ACT 1982
and jumped back. When it did so he left the cattle prod dangling through
the fence above the prone Mr Mncube as a deterrent.
The tiger then came back in and grabbed Mr Mncube again, this time in
DOLI 9 9(2) & Ferreira
the upper body area and dragged or flicked him away from the fence. Mr
(a)
Ferreira then came down to the fence where 9(2)(a) was and they tried
to get the cattle prodder through but it would not fit, nor could it be thrown
over the top of the fence due to the risk of it being damaged.
Both Messrs 9(2) and Ferreira ran to the gate and the cattle prodder was
DOLI 9 Ferreira
passed through.
(a)
Mr Ferreira then went back towards the tiger and Mr
Mncube, as he approached the tiger it started to bite Mr Mncube about
INFORMATION
the neck and head. Mr Ferreira said he could hear the bones cracking. At
this point he said he knew that Mr Mncube was probably dead.
While 9(2)(a) ran to get a firearm from the gun cabinet in the ‘Tardis’ to
DOLI 9 9(2)
shoot the tiger Mr Ferreira used the prodder on the tiger to try and get it to
(a)
move away from the prone Mr Mncube, resulting into the tiger dragging
DOLI 9 Ferreira
Mr Mncube towards the centre of the enclosure under the trees. A brief
DOLI 9 9(2)(a)
discussion between Messrs 9(2)(a)
and Ferreira also took place, with
Mr Ferreira asking for help and 9(2)(a)
saying ‘we can’t come in
as both tigers are stil within the enclosure’.
9(2)(a)
called for a vehicle to be brought down to Enclosure 9 to
DOLI 9 9(2)(a)
carry Mr Mncube out and towards the main gates. 9(2)(a)
arrived on
a quad bike and 9(2)(a)
said ‘no, we need an enclosed vehicle’
DOLI 9 9(2)(a)
and she left to get a ute from the house above Enclosure 2.
9(2)(a)
returned with a shotgun and from the top side of the enclosure
DOLI 9 9(2)
looked to see if he could shoot the tiger, but it was not possible. Mr
(a)
Ferreira asked 9(2)(a) not to shoot the tiger, at least not yet. 9(2)(a)
then went around the end of the enclosure to about the position he was in
when he had used the cattle prod.
At about the same time 9(2)(a)
had arrived at the main gate
DOLI 9 9(2)(a)
to the enclosure as she was trained in First Aid. Abu, the tiger had moved
away from Mr Mncube and was sitting on the lower of two large rocks and
Mr Ferreira was standing alongside the body of Mr Mncube with the cattle
RELEASED UNDER THE OFFICIAL
prod. Mr Ferreira was asked by 9(2)(a)
to attempt CPR on Mr
DOLI 9 Ferreira
Mncube but said he couldn’t as he would have had to have bent down
and taken his attention off the two tigers.
DOLI 9 9(2)
(a)
DOLI 6 – Summary of Evidence – Version 1 – o9/2004
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Page 9 of 18
Where Evidence
Recorded & How
Element Proved
Facts (cont.)
9(2)(a)
said that they did not want to shoot the tiger and that they
DOLI 9 9(2)(a)
decided to try and get the vehicle (the ute) into the enclosure. 9(2)(a)
said he felt comfortable that he could do that. When they went to open the
gate to get the vehicle in the tiger (Abu) “chal enged” them. It did not
aggressively charge them but did get up immediately and go towards
them.
Messrs 9(2)(a) Ferreira and 9(2)(a)
talked with others, including
DOLI 9 9(2)(a)
,
having
ACT 1982
9(2)(a)
calling Mrs P Busch on the radio and asking for
Ferreira,9(2)(a)
permission to shoot the tiger. 9(2)(a) positioned himself along the lower
DOLI 11/21 Police scale
fenceline of the enclosure and fired up at the tiger Abu that was sitting on
plan
the lower of two large rocks.
9(2)(a)
said he fired the first of three shots at the tiger from this position.
DOLI 9 9(2)
The tiger appeared to have been wounded by the shots but was stil able
(a)
to get up and move around, although did not look to be comfortable.
9(2)(a)
then handed the shotgun to 9(2)(a)
before he could drive
DOLI 9 9(2)
the ute in opened the gate and dragged a small log out of the way so it
DOLI 9 (a)
9(2)(a)
didn’t impede the vehicle. 9(2)(a)
drove the ute into the enclosure with
INFORMATION
9(2)(a)
opening to allow him in and immediately closing the
gate behind him.
9(2)(a)
drove the ute parallel with the bottom fence of the enclosure up
DOLI 11/21 Police scale
plan
to where Messrs Mncube and Ferreira were just on the edge of the trees.
When he hopped out of the ute he told Mr Ferreira to watch the tigers and
DOLI 9 9(2)
that he would get Mr Mncube into the back of the ute.
(a)
Despite his best efforts 9(2)(a) was unable to lift the body of Mr Mncube
DOLI 9 9(2)
and so Mr Ferreira helped him. 9(2)(a)
got back into the drivers seat
(a)
and Mr Ferreira got in behind him but on the same side. He then reversed
DOLI 11/21 Police scale
down towards the bottom corner of the enclosure (effectively a three point
plan
turn) before driving back towards the gate.
9(2)(a)
opened the gate again to allow the ute with Messrs
DOLI 9 9(2)
Mncube, 9(2) and Ferreira back out. 9(2)(a) stopped briefly to make
(a)
sure that the
(a) y got the gate was closed again. As soon as he was sure the
gate was locked he drove off towards the front gates of the Park.
9(2)(a)
, who had come down to the main gate to care for the visitors
DOLI 9 9(2)
and coordinate things and saw the Ambulance coming down the road as
(a)
Messrs 9(2)(a) Ferreira and Mncube arrived. 9(2)(a)
unlocked the gate
DOLI 9 9(2)
to allow the Ambulance in.
(a)
The Ambulance personnel examined Mr Mncube who was stil in the back
DOLI 11/12 St John
of the ute and observed that he had significant head, facial and throat
Patient Report Form
injuries, along with multiple puncture wounds to the upper body. They
RELEASED UNDER THE OFFICIAL
found him to be unconscious / unresponsive with no respiratory effort or
palpable pulse. When they placed a monitor on Mr Mncube it showed
asystole. Based on their observations they believed that life was extinct
Add to Glossary Asystole
and did not attempt resuscitation.
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Page 10 of 18
Where Evidence
Recorded & How
Element Proved
Facts (cont.)
Notification & Response
The tiger attack on Mr Mncube was reported by phone to the Department
DOLI 11/1
of Labour’s Contact Centre by Police and Mrs P Busch at approximately
11.30 a.m. as a serious harm event and promptly passed to the
Whangarei office of the Department for action. Mr Hol and also notified
Health and Safety Inspector Mark Montgomery (Mr Montgomery) of the
attack personally.
Whangarei based Health and Safety Inspectors Mr Montgomery and
ACT 1982
Shona Kelly (Ms Kelly) were tasked by their Service Manager, Ian Baxter
(Mr Baxter) with the investigation into this event with Mr Montgomery to
be the lead.
Before they could respond to the site confirmation was received from
Police that Mr Mncube had died because of the injuries he had received
DOLI 11/1
in the attack. Mr Montgomery contacted Rachelle Linwood (Ms Linwood),
Team Manager, Animal Imports from MAF Head Office and informed of
the attack and the resulting death. Ms Linwood asked that they be kept
informed and that she would be back in touch with details of the MAF
response to this event.
INFORMATION
Mr Montgomery and Ms Kelly arrived at ZWG at approximately 12.10 p.m.
Once on site they met with the Police Officer-in-charge Inspector Paul
DOLI 11/3 Notebook
Dimery (Inspector Dimery) and discussed what had occurred, the location
Entries - Montgomery
of all witnesses and the safety of other people along with the animals (on
behalf of MAF) within the facility. They also discussed the status of the
tiger involved and confirmed with Police that it had been shot and kil ed by
park employees just after Police had arrived on scene.
DOLI 9 9(2) & Ferreira
(a)
It was agreed that for the initial investigation they would form a joint
Investigation Team comprising Mr Montgomery, Ms Kel y and Inspector
Dimery and that they would ensure that throughout the various agency
investigations that they would keep each other informed.
The body of Mr Mncube was stil in the rear of the ute he had been
brought down to the gate in and this was parked just off to the side of the
DOLI 21 Police Photos
main entrance. The Investigation Team walked to the enclosure where
_MG_8642 to 8645
the attack had taken place. They viewed and photographed the dead tiger
that had been dragged out of the den by ZWS employees after it was
DOLI 10 Exhibit
kil ed so that the female tiger Rewa could be secured.
NTH/498/0002
They also looked at the general setup in the enclosure without entering it.
Employees of ZWS had managed to get the female tiger Rewa secured in
the den after removing the body of Abu. Inspector Dimery advised that he
had called for the Police photographers to attend and for the Serious
Crash Unit (SCU) to record the scene within the enclosure and
DOLI 11/21 Police scale
plan
trajectories of the shots fired.
RELEASED UNDER THE OFFICIAL
DOLI 6 – Summary of Evidence – Version 1 – o9/2004
Element to prove is indicated in
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Page 11 of 18
Where Evidence
Recorded & How
Element Proved
Facts (cont.)
After viewing the body of Mr Mncube at about 12.40 p.m. the Investigation
DOLI 10 Photo Exhibits
NTH/498/0003-0004,
Team agreed that they needed to have a detailed look at the scene within
0006-0007, 0009-0011
the enclosure. Inspector Dimery, Mr Montgomery and the Police
DOLI 21 Police Photos
Photographer entered Enclosure 9 at about 12.55 p.m. Arrangements
_MG_9654 to _MG_8696
were made for them to be guarded whilst in the enclosure by 9(2)(a)
who would be armed with the Magnum rifle.
The Investigation Team received advice that the Northland Coroner
Brandt Shortland (Coroner) had arrived and leaving the Police
ACT 1982
Photographer under armed guard in Enclosure 9, made their way back to
the main gate. The Investigation Team met with the Coroner and briefed
him on the facts available to them at that time.
They worked with the Coroner to ensure his needs were met in terms of
the Coronial Investigation. After viewing the body of the deceased the
Coroner and the investigation Team made their way down to Enclosure 9.
Again they briefed the Coroner on what had occurred there.
To allow the Senior Constable from SCU to adequately survey and map
DOLI 10 Photo Exhibit
the scene inside Enclosure 9, Police asked Mr Holland if it was possible
NTH/498/0012
to relocate the remaining tiger Rewa to another enclosure. After some
INFORMATION
discussion it was agreed that the employees on-site had neither the
equipment required nor their heads in the right space to attempt this at
present. Agreement was reached that fixing heavy steel mesh across the
front of the den would provide adequate protection for the SCU whilst
undertaking the survey, and ZWS employees did this.
After further discussions with Mr Holland it was agreed that the Auckland
DOLI 11/3
Zoo veterinary team would be on-site the following day to tranquilise the
remaining tiger, Rewa, in Enclosure 9 so that the final part of the scene
examination could be completed.
During discussions with Police and MAF Mr Montgomery had raised
concerns regarding maintaining the welfare of the cats. He had checked
with Mr Holland if anything urgently needed to be done and was advised
that there was no immediate need for employees to enter enclosures for
the next 24 hours at least.
MAF Team Manager, Operations & Facilities Howard Hamilton (Mr
Hamilton) telephoned Mr Montgomery to confirm that they had directed
that the facility close to the public pending further investigations. Mr
Hamilton also advised that he and his manager would be in Whangarei
and visiting the site the following day as part of MAF’s investigations.
Mr Montgomery discussed the investigation with both Mrs P Busch and
Mr Hol and at about 1.30 p.m. He verbally directed that effective
immediately no employees or other persons were to enter any enclosure
RELEASED UNDER THE OFFICIAL
where the animals were not able to be isolated by being locked away in
dens or another area away from the primary enclosure, and that this
would be reviewed the next day with MAF officials.
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Element to prove is indicated in
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Page 12 of 18
Where Evidence
Recorded & How
Element Proved
Facts (cont.)
As it was unclear what may have lead to the attack on Mr Mncube by the
tiger Mr Montgomery sourced (through MAF) a specialist animal
pathologist to undertake a full necropsy on the tiger the next day to
determine if there was anything physiologically or chemically wrong with
it.
Mr Montgomery ensured that his Manager Mr Baxter was kept informed.
DOLI 11/3
He also kept in touch with MAF, primarily through Ms Linwood. The
Investigation Team were aware of the high level of media interest with TV
ACT 1982
crews arriving by road and helicopters flying over the scene to film it.
Ms Kel y took contemporaneous notes and brief statements from some of
DOLI 11/21
the witnesses. Police interviewed the visitors who had made up the tour
group, in some cases with the assistance of interpreters.
Mr Montgomery explained to Mr Holland and Inspector Dimery that he
DOLI 10 Photo Exhibit
had arranged for a necropsy on the dead tiger by a person recommended
NTH/498/0014
to him by MAF for the following day. He directed that the body of the tiger
be removed from its current location and placed in a chil er (not freezer)
and not be disturbed.
INFORMATION
After confirming with Mr Holland that the body of the tiger was secured Mr
Montgomery informed him that they would be back the next day to
continue the investigation. The Investigation Team then met in the retail
shop at the main gate to discuss what might be provided to the waiting
media, to debrief and discuss the investigation going forward.
Inspector Dimery advised that they had arranged for a number of the
ZWS employees to travel to the Whangarei Police Station the following
morning to be formally interviewed, and that the Department was
welcome to observe and assist.
With the debriefing completed Mr Montgomery and Ms Kelly left the site
for the day. They returned to their Whangarei office to brief Mr Baxter and
commence the formal internal reporting processes.
On 28 May 2009 Mr Montgomery met with Mr Hamilton and his manager,
Clive Gower-Collins (Mr Gower-Collins), MAF Group Manager,
Operations & Facilities, at the Department’s Whangarei offices and
discussed with them the previous day’s events and showed them the
photographs taken by him. It was agreed that they would meet up and
discuss matters during the course of the day at ZWG.
Mr Montgomery and Ms Kelly went to the Whangarei Police Station at 9
o’clock to meet with Inspector Paul Dimery and his team to discuss and
observe the interviews with ZWS employees as arranged yesterday with
ZWS and ZWG management.
RELEASED UNDER THE OFFICIAL
DOLI 6 – Summary of Evidence – Version 1 – o9/2004
Element to prove is indicated in
bold type
Page 13 of 18
Where Evidence
Recorded & How
Element Proved
Facts (cont.)
When the ZWS employees did not turn up as arranged Mr Montgomery
contacted Mr Holland to try and find out what was happening. Mr Holland
advised that the Auckland Zoo team are on-site and staff cannot be
released. Inspector Dimery determined that Police wil go to park in
numbers and complete the required interviews on-site.
Mr Montgomery and Ms Kelly follow Police to ZWG site. They meet with
Auckland Zoo team and observed the processes for relocating the
required animals. After the Auckland Zoo veterinary team had tranquilised
DOLI 10 Photo Exhibits
ACT 1982
and removed Rewa the remaining tiger from the Enclosure 9 den. Once
NTH/498/0015-0020
DOLI 11/3
rewa was removed Mr Montgomery examined the den, measuring and
DOLI 10 Sketch
taking photographs of the interior of it.
NTH/498/0005
Mr Montgomery spoke with Mr Nalder and determined his role in the work
at ZWG. Mr Nalder confirmed he could speak on behalf of the companies
(ZWS and ZWG) and Mr Montgomery recorded his contact details and
advised that he would arrange a formal interview in due course.
Messrs Montgomery, Hamilton and Gower-Collins and Ms Kelly,
accompanied by Messrs Holland and Davis, met and walked through the
entire site to look at each enclosure and determine what needed to be
INFORMATION
done to bring it up to MAF standards and to be able to lock the animals it
DOLI 11/3 ZWG Enclosure
contained away while employees entered for the purposes of cleaning,
ID annotated
etc.
During the examination of the enclosures it was agreed that pending
changes made so that each and every enclosure contained a separate
area in which to lock the animals, where it was currently not possible to
lock the animals away then a minimum of four (4) employees would need
to be involved in any entry, two of whom would be armed with suitable
firearms.
Mr Montgomery confirmed with Mr Hol and and the MAF officials that the
Department would prepare and serve Improvement Notices to that effect
before the end of the day.
Dr Keith McSporran (Dr McSporran) arrived from Auckland to perform the
necropsy of the dead tiger Abu. Mr Montgomery met with him and briefed
him on what the Department required and established what assistance, if
any he needed. After looking at where the tiger was stored he agreed that
he would work on the floor directly in front of the chil er as it was shaded
and could be easily cleaned.
Mr Montgomery and Ms Kelly observed the start of the necropsy then left
DOLI 10 Photo Exhibits
Dr McSporran to continue with the necropsy while they did other work
NTH/498/0023-0028
around the site.
RELEASED UNDER THE OFFICIAL
Dr McSporran completed the necropsy at about 2.20 p.m. and Mr
DOLI 11/3
Montgomery discussed with him his observations and asked what
samples he was taking, recording this in his notebook, so he could
DOLI11/26
prepare a Notice under Section 33 of Act to serve on ZWS.
DOLI 6 – Summary of Evidence – Version 1 – o9/2004
Element to prove is indicated in
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Page 14 of 18
Where Evidence
Recorded & How
Element Proved
Facts (cont.)
Consent had to be obtained from MAF and ERMA for these samples to be
removed from site for further analysis, and this was granted verbally by
Mr Hamilton.
After advising Mrs P Busch and Mr Hol and that Improvement Notices
would be served on ZWS once they were prepared, Mr Montgomery and
DOLI 11/10
Ms Kelly left the site at approximately 3 o’clock.
Mr Montgomery believing that ZWS employees were not safe when
ACT 1982
required to enter big cat enclosures where animals were unable to be
DOLI 11/10 Improvement
securely isolated by being locked in dens or similar returned to the
Notice 19853
Department’s offices where he prepared two (2) Improvement Notices
under Section 6 of the Act requiring ZWS to:
1. Ensure all enclosures met MAFBNZ standards so that any adult
DOLI 11/10 Improvement
big cat in the enclosure can be isolated to ensure the safety of any
Notice 19854
employee required to work in there; and
2. As an interim measure, pending the upgrade of enclosures as per
the first Improvement Notice, that any employee required to enter
any enclosure where any big cat cannot be securely isolated, must
be guarded by two (2) employees with loaded firearms.
INFORMATION
Mr Montgomery personally served these on Mrs P Busch at the office of
ZWS at 7.51 p.m. on the 28 May 2009, in the presence of 9(2)(a)
Once these Improvement Notices were deemed to have been complied
DOLI 11/11
with, and after confirming with MAF that their requirements in respect of
the enclosures had been met Mr Montgomery, on 17 June 2009 prepared,
affixed and served on ZWS a Prohibition Notice requiring that al activities
that put employees (including volunteers) into direct contact with adult
lions, tigers or leopards are to be eliminated.
On 17 June 2009 Mr Montgomery also served ZWS with four (4)
Improvement Notices as follows:
DOLI 11/10
1. Under Section 10(2)(a) of the Act to develop and implement
suitable standard operating procedures for any work between
employees and the adult lions, tigers or leopard; and
2. Under Section 10(2)(c) of the Act to implement a regime whereby
the health and safety of all employees at work is to be routinely
monitored to ensure that compliance with the requirements of the
Act and the employers Standard Operating Procedures are
achieved, and in particular the restriction on direct contact with
adult lions, tigers and leopards; and
3. Under Section 12(1)(a)-(d) of the Act to ensure that information on
the standard operating procedures developed is provided, in such
a form and manner that is reasonably expected to be understood,
to all employees who work around the adult lions, tigers and
leopards; and
RELEASED UNDER THE OFFICIAL
4. Under Section 13(a) and (b) of the Act to take all practicable steps
to ensure that suitable training is provided to all employees in
respect of the Standard Operating Procedures that have been
developed for employees who work around the adult lions, tigers
and leopards.
DOLI 6 – Summary of Evidence – Version 1 – o9/2004
Element to prove is indicated in
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Page 15 of 18
Where Evidence
Recorded & How
Element Proved
Analysis
Section 6 of the Health and Safety in Employment Act 1992 (the Act)
required ZWS as an employer to take all practicable steps to ensure the
safety of employees Messrs Mncube and Ferreira while they were at
work, and in particular that while they were at work they were not exposed
to hazards arising out of the organisation of things in their place of work.
Section 16 of the Act required ZWG as the person in control of a place of
work to ensure that no hazard that is or arises in the place harmed
people, Messrs Mncube and Ferreira, who were lawfully at work in the
ACT 1982
place.
Section 17 of the Act required Mr Holland as a self-employed person to
take all practicable steps to ensure that no action or inaction by him while
at work harmed him or any other person.
Section 18 of the Act required ZWG as a principal to take all practicable
steps to ensure that no employee (Messrs Mncube and Ferreira) of ZWS
a contractor, were harmed while doing any work that the contractor was
engaged to do.
INFORMATION
Section 19 of the Act required Mr Mncube as an employee to take all
practicable steps to ensure that no action or inaction on his part caused
harm to him or any other person.
DOLI 11/16
Section 19 of the Act required Mr Ferreira as an employee to take all
practicable steps to ensure that no action or inaction on his part caused
harm to him or any other person.
Hazards Involved
Any situation, whether deliberate or otherwise that allows people to
occupy the same space as unrestrained adult lions, tigers or leopards
could be deemed a “significant hazard” situation.
This is proven by three separate big cat attacks at the ZWG site in the last
two years that have resulted in people being seriously harmed.
Contributing causes
DOLI 13
The operations at the ZWG site had grown from a handful of people under
the management of its former Operator and Manager, Craig Busch (Mr C
Busch). From the outset it appears that the primary focus of the ZWG
operations was that Mr C Busch and other people would have direct
interaction with the big cats.
ZWG had some documented health and safety systems as were obtained
or provided during this investigation. We believe that the day to day
DOLI 13
RELEASED UNDER THE OFFICIAL
operations at the site did not provide for effective health and safety
management for persons on the site. Almost all documentation relating to
the health and safety systems and the operations manuals for the site
appear to bear ZWG rather than ZWS identification, including memos to
employees, operations manuals, etc.
DOLI 6 – Summary of Evidence – Version 1 – o9/2004
Element to prove is indicated in
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Page 16 of 18
Where Evidence
Recorded & How
Element Proved
Analysis (cont.)
At the time of Mr Mncube’s death ZWS as the employer of Mr Mncube
was relying entirely on what had previously been developed by ZWG for
its health and safety management systems. These systems were not
DOLI 13
adequate as they did not identify what the hazards or significant hazards
that employees were or might be exposed to were, nor were adequate
controls in place.
After a serious harm injury to a volunteer employee Lisa Baxter (Ms
Baxter) on 23 April 2008 was reported to the Department by a local
ACT 1982
newspaper, Mr Montgomery investigated. As a result he identified a
DOLI 13
number of health and safety shortcomings at ZWS including the lack of
effective health and safety management systems. The investigation
resulted in a Written Warning being issued to ZWS under Section 25 of
the Health and Safety in Employment Act 1992.
Mr Montgomery had tried to assist ZWS with a view to having them
implement steps to improve their health and safety management systems.
On the 12th of May 2008 he met at ZWG with Mrs P Busch and the then
health and safety representative 9(2)(a)
During the
meeting he explained what the Act required of employers, and how ZWG,
as an employer, could implement effective health and safety management
INFORMATION
systems. He provided them with a hard copy of a simple health and safety
management policies and procedures document.
On 19 March 2009 a serious harm injury to a ZWS employee Demetri
Price (Mr Price) occurred when he was attacked and bitten by the male
tiger Abu. This attack resulted in significant bites to both Mr Price’s knee’s
and occurred while the tigers Abu and Rewa were being relocated from
one enclosure to Enclosure 9 where the fatal attack on Mr Mncube
occurred on 27 May 2009.
The investigation into the accident to Mr Price was ongoing at the time of
Mr Mncube’s death, and Mr Mncube had been interviewed by Mr
Montgomery as part of that investigation as he was one of the key
witnesses, along with other employees and contractors.
At the time of the tragic death of Mr Mncube ZWG as the probable
principal to ZWS appeared to have no effective health and safety
management systems in place.
Practicable steps that could have been taken
DOLI ??
The Act sets out a hierarchy of control that requires employers to manage
significant hazards in a straightforward and specified manner. In Section 8
of the Act employers are first required to take all practicable steps to
eliminate significant hazards. This Department does not advocate that the
big cats at ZWG should be eliminated.
RELEASED UNDER THE OFFICIAL
DOLI 6 – Summary of Evidence – Version 1 – o9/2004
Element to prove is indicated in
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Page 17 of 18
Where Evidence
Recorded & How
Element Proved
Analysis (cont.)
The Act in Section 9 to require employers, where elimination is
impossible, to take all practicable steps to isolate the significant hazards
from the employees. Practical examples if how industry uses isolation to
DOLI 11/15
ensure the safety of employees at work are guarding machinery, the
provision of scaffolding, the use of trench shields, etc.
The simple and practicable step that could have been taken to ensure the
safety of Messrs Mncube and Ferreira, which was to require that the adult
big cats were locked in their dens before they entered the enclosures.
ACT 1982
From what the Department has been able to establish all zoo’s in New
Zealand lock their adult big cats away in dens when employees are
DOLI 11/16 Park Manual,
required to enter the enclosures. Internationally this is also recognised as
Version 4
a practicable step.
As wel as the incidents at ZWG there was an attack by two juvenile lions
on an employee at Wel ington Zoo on 10 January 2006 that the
Department investigated.
Internationally there appears to be a consensus amongst the professional
zoo communities that animals such as tigers and lions are best kept
INFORMATION
isolated from people, including their keepers. This is reflected in such
documents as the United Kingdom’s Health and Safety Executive
publication
‘Managing health and safety in zoos’.
ZWS and ZWG were aware of the MAFBNZ Standard 154.03.04
Containment Facilities for Zoo Animals (Zoo Standard) which addressed
how large carnivores were to be kept and the steps to be taken to ensure
public and employee safety. The Zoo Standard at Schedule 1, 8.2.4
Keeper Safety (page 34) states in point 4:
All animals shall be removed from their enclosure into night dens / short-
term secure holding pens before any animal care personnel shall be
allowed to enter the enclosure.
ZWG documents such as the Park Manual, Version 4, April 20th 2006 at
2.3.2 on page 14 required “
Any staff entering enclosures on their own are
the ensure that the cats are locked away securely with safety chains /
catches in place’.
The same Park Manual, at page 11 states “
By December 2006, all cat
enclosures will contain the following;
Double door entry
DOLI 3
Clearly ZWS and ZWG were not following either the Zoo Standard or their
own rules to ensure the safety of their employees.
Conclusions
RELEASED UNDER THE OFFICIAL
ZWS, as the employer of Messrs Mncube and Ferreira appears to have
breached Section 6 of the Heath and Safety in Employment Act 1992 by
failing to ensure that they provided a safe place of work.
DOLI 6 – Summary of Evidence – Version 1 – o9/2004
Element to prove is indicated in
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Page 18 of 18
Where Evidence
Recorded & How
Element Proved
Conclusions (cont.)
Mr Hol and, as a self-employed person does not appear to have failed in
his duties under Section 15 of the Heath and Safety in Employment Act
1992 to ensure that no action or inaction on his part caused harm ti any
other person.
ZWG was either a person in control of a place of work under Section 16 of
the Heath and Safety in Employment Act 1992 or a principal to ZWS
under Section 18 of the Act and appears to have failed to ensure the
safety of Messrs Mncube and Ferreira as persons lawfully in the place of
ACT 1982
work (Section 16) or as employees of a contractor (ZWS) Section 18).
Messrs Mncube and Ferreira, as employees of ZWS do not appear to
have failed in their duties under Section 19 of the Heath and Safety in
Employment Act 1992.
Recommendations
1. That ZWS be prosecuted for the apparent breaches of Section 6
of the Heath and Safety in Employment Act 1992.
DOLI 3
INFORMATION
2. That ZWG be prosecuted for the apparent breaches of Section 16
DOLI 3
or 18 of the Health and Safety in Employment Act 1992.
RELEASED UNDER THE OFFICIAL
DOLI 6 – Summary of Evidence – Version 1 – o9/2004
Element to prove is indicated in
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