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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
    Anthony Joseph Mansbridge COR 2011 0156 Finding into death with inquest 06/06/2012 Deputy State Coroner Iain West
    Rex William Foster COR 2011 3616 Finding into death without inquest 05/06/2012 Coroner Jonathan G Klestadt
    Robert Dunlop COR 2011 0581 Finding into death with inquest 04/06/2012 Coroner Kim M. W. Parkinson
    Patricia Parkes COR 2011 3775 Finding into death with inquest 04/06/2012 Coroner Kim M. W. Parkinson
    Phong Cao COR 2011 2734 Finding into death with inquest 04/06/2012 Coroner Audrey Jamieson
    Rosemary McGarrity COR 2011 1390 Finding into death with inquest 04/06/2012 Coroner Kim M. W. Parkinson
    Michael Cleary COR 2011 1348 Finding into death with inquest 04/06/2012 Coroner Kim M. W. Parkinson
    Nathan Fazal Francis COR 2007 1212 Finding into death with inquest 01/06/2012 Coroner Audrey Jamieson
    Dean Smith COR 2008 4361 Finding into death with inquest 23/05/2012 Coroner Jacinta Heffey
    David Andrew Trengrove COR 2008 4042 Finding into death with inquest 18/05/2012 Coroner Audrey Jamieson