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 |
---|---|---|---|---|---|---|
Aluel Ajak | COR 2023 003665 | Finding into death without inquest | 29/07/2025 | Coroner David Ryan | ||
Juvetta Pedruco Columbine | COR 2024 006286 | Finding into death without inquest | 28/07/2025 | State Coroner Judge John Cain | ||
Heather Ida Simone Calgaret | COR 2021 006365 | Finding into death with inquest | 28/07/2025 | Coroner Sarah Gebert | ||
GVY . | COR 2022 006944 | Finding into death without inquest | 28/07/2025 | State Coroner Judge John Cain | ||
Shane Michael Kelly | COR 2024 002947 | Finding into death without inquest | 25/07/2025 | Coroner Simon McGregor | ||
Silvie Marion Burton | COR 2024 005013 | Finding into death without inquest | 25/07/2025 | Coroner Simon McGregor | ||
Bruce David Manintveld | COR 2024 000868 | Finding into death without inquest | 25/07/2025 | Coroner Simon McGregor | ||
Jill Hughes | COR 2024 001802 | Finding into death without inquest | 25/07/2025 | Coroner Simon McGregor | ||
Ann Williams | COR 2024 005697 | Finding into death without inquest | 24/07/2025 | Coroner Simon McGregor | ||
Helena Zoe Broadbent | COR 2019 005285 | Finding into death without inquest | 23/07/2025 | State Coroner Judge John Cain |