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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 Sort descending Date Coroner Related orders and rulings Responses to recommendations
    LP COR 2011 2111 Finding into death with inquest 11/10/2013 Deputy State Coroner Iain West
    Keith William Allan COR 2010 2171 Finding into death with inquest 27/02/2012 Coroner Dr Jane Hendtlass
    Unknown remains comprising bones COR 2012 2319 Finding into death with inquest 05/12/2013 Coroner Kim M. W. Parkinson
    William Aubrey Thompson COR 2003 2370 Finding into death with inquest 29/06/2017 State Coroner Judge Sara Hinchey
    Robert William Keith COR 2010 2434 Finding into death with inquest 28/06/2011 Coroner F Hayes
    Rosemary Auchettl COR 2010 2564 Finding into death with inquest 16/08/2012 Coroner Heather Spooner
    Cherie Deanne Alderson COR 2010 2679 Finding into death with inquest 21/07/2011 State Coroner Judge Jennifer Coate
    Tony Fishwick COR 2009 2746 Finding into death with inquest 23/12/2010 Coroner Peter Couzens
    Steve Gulyas COR 2003 3526 Finding into death with inquest 11/04/2011 State Coroner Judge Jennifer Coate
    Barry Wilson Howroyd COR 2008 3593 Finding into death with inquest 31/08/2011 Deputy State Coroner Paresa Spanos