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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
    Kelly Ann Thompson COR 2014 0824 Finding into death with inquest 21/04/2016 State Coroner Judge Ian L Gray
    Gregory Jon Andrews COR 2008 4550 Finding into death without inquest 20/04/2016 Coroner Audrey Jamieson
    Scott Thompson COR 2014 0690 Finding into death without inquest 19/04/2016 Coroner Peter White
    Noah Cheron-Duncan COR 2014 5867 Finding into death without inquest 19/04/2016 Coroner Peter White
    Chris Pravin Prasad COR 2013 0273 Finding into death with inquest 19/04/2016 Coroner Audrey Jamieson
    Patricia O'Keefe COR 2014 3952 Finding into death without inquest 15/04/2016 Coroner Caitlin English
    Alfred Norman Avage COR 2014 4527 Finding into death without inquest 14/04/2016 Deputy State Coroner Paresa Spanos
    Oscar Nicholas McIntyre COR 2012 0741 Finding into death without inquest 14/04/2016 Coroner Rosemary Carlin
    Miriam Ralph COR 2014 2362 Finding into death without inquest 14/04/2016 Coroner Caitlin English
    Kelly Maree Richards COR 2011 2565 Finding into death with inquest 14/04/2016 Deputy State Coroner Iain West