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Findings

A written finding is a formal document handed down by a coroner following an investigation into a death or fire and is generally the final step in the coronial investigation process. A written finding is made regardless of whether an inquest is held or not.

A written finding following an investigation into a death will usually, if possible, include:

  • the identity of the person who died
  • the time, date, and location where the death occurred
  • a summary of the evidence relating to the circumstances of the death, in some cases
  • comments or recommendations made by the coroner aimed at preventing similar deaths, in some cases.

Findings are published when:

  • an inquest was held
  • recommendations have been made
  • a coroner otherwise orders they be published.

Findings handed down and published are available below.

Search older findings on the Australasian Legal Information Institute database (AustLII).

Please consider that it may be upsetting to read details about a death or fire in an inquest finding. Some information may be graphic or distressing.

Use the search field above to locate a finding. You can search for a name, a case number, type of death or location of death.

Any person may apply for some or all of a finding to be reviewed and/or appealed.

Recommendations

The Coroners Act 2008 allows a coroner to make recommendations as part of their finding following an investigation into a death or fire.

Recommendations can be made to any Minister, public statutory authority or entity that may help prevent similar deaths. A public statutory authority or entity who receives a recommendation from a coroner must respond, in writing, within three months stating what action, if any, has or will be taken.

The Court will publish inquest findings with recommendations and the subsequent responses below.

Findings list

Name Case ID Case type Date Sort ascending Coroner Related orders and rulings Responses to recommendations
Antonio Vitelli COR 2023 005258 Finding into death without inquest 01/11/2024 Coroner Kate Despot
Marina Norman COR 2023 001959 Finding into death without inquest 01/11/2024 Coroner Paul Lawrie
Robin James Woller COR 2023 000994 Finding into death without inquest 31/10/2024 Coroner Paul Lawrie
Tamara Kudeviita COR 2023 000053 Finding into death without inquest 30/10/2024 Coroner Audrey Jamieson
Munif Mohammed COR 2023 003167 Finding into death with inquest 29/10/2024 Deputy State Coroner Paresa Spanos
Constantin Daoussianis COR 2023 002182 Finding into death without inquest 29/10/2024 Coroner Audrey Jamieson
Loreta Maria Del Rossi COR 2024 002832 Finding into death without inquest 28/10/2024 State Coroner Judge John Cain
Thanh Nguyen COR 2024 002678 Finding into death with inquest 25/10/2024 Coroner Leveasque Peterson
E K COR 2019 002791 Finding into death without inquest 25/10/2024 Coroner Ingrid Giles
Bekkie-Rae Curren COR 2019 006509 Finding into death without inquest 25/10/2024 State Coroner Judge John Cain