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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
Doris Pearl Townsend COR 2015 4244 Finding into death without inquest 30/06/2016 Coroner Audrey Jamieson
Mary Veronica Levin COR 2014 3913 Finding into death without inquest 30/06/2016 Coroner Rosemary Carlin
Aaron Jesse Fryer COR 2011 1895 Finding into death with inquest 30/06/2016 Coroner Rosemary Carlin
Michael Sean Daly COR 2015 4274 Finding into death without inquest 28/06/2016 Coroner Audrey Jamieson
Graeme John Jennings COR 2012 1491 Finding into death with inquest 24/06/2016 Coroner Phillip Byrne
SJD COR 2014 5071 Finding into death without inquest 24/06/2016 Deputy State Coroner Paresa Spanos
Adam James Vincent Pearson COR 2013 2331 Finding into death without inquest 24/06/2016 Coroner Caitlin English
Wendy Elizabeth Pennycuick COR 2015 5028 Finding into death with inquest 24/06/2016 Deputy State Coroner Paresa Spanos
John Charles Prohasky COR 2013 2681 Finding into death without inquest 23/06/2016 Coroner Audrey Jamieson
Danielle Maxine Lewis COR 2014 4730 Finding into death without inquest 22/06/2016 Coroner Audrey Jamieson