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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
    Beverley Joy Leggett COR 2014 6263 Finding into death without inquest 10/11/2016 Coroner Caitlin English
    Troy Daniel Saint COR 2013 0855 Finding into death without inquest 07/11/2016 Coroner Audrey Jamieson
    Zane Bradbury COR 2014 2384 Finding into death without inquest 28/10/2016 State Coroner Judge Sara Hinchey
    Peter Edward Hall COR 2013 4912 Finding into death without inquest 28/10/2016 Deputy State Coroner Paresa Spanos
    Gladys Yvonne Melhuish COR 2015 1799 Finding into death without inquest 25/10/2016 Coroner Caitlin English
    Andrew Michael ODonnell COR 2012 5516 Finding into death with inquest 25/10/2016 Coroner Audrey Jamieson
    Child A COR 2014 5251 Finding into death without inquest 24/10/2016 Coroner Audrey Jamieson
    Anita Kalnins COR 2014 5652 Finding into death without inquest 10/10/2016 Coroner Audrey Jamieson
    Milica (Mary) Minchev COR 2013 0880 Finding into death without inquest 07/10/2016 Coroner Audrey Jamieson
    Martha Alice Fraser COR 2011 2291 Finding into death with inquest 06/10/2016 Coroner Caitlin English