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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
    Susan Ruth Lovell COR 2013 4813 Finding into death without inquest 02/03/2016 Coroner Rosemary Carlin
    Chloe Kathleen Gent COR 2012 0463 Finding into death without inquest 29/02/2016 Coroner Phillip Byrne
    Yamini Bhadrayu Patel COR 2009 4996 Finding into death with inquest 29/02/2016 Coroner Audrey Jamieson
    Maree Rosalie Jones COR 2013 0655 Finding into death with inquest 26/02/2016 Coroner Caitlin English
    Jonas Jvirblis COR 2012 4882 Finding into death without inquest 26/02/2016 Coroner Caitlin English
    Ena Edith Vickers COR 2012 3130 Finding into death with inquest 25/02/2016 Coroner Phillip Byrne
    Andrew Hepple Pattison COR 2009 3760 Finding into death with inquest 24/02/2016 Coroner Audrey Jamieson
    Kilmore East Fire COR 2009 1496 Finding into fire without inquest 23/02/2016 State Coroner Judge Ian L Gray
    Lorraine Mary Bartolome COR 2015 2802 Finding into death without inquest 17/02/2016 Coroner Jacqui Hawkins
    Emmerson Elizabeth Boyle COR 2014 4503 Finding into death without inquest 17/02/2016 Coroner Peter White