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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
    Peter Robin Tully COR 2007 0791 Finding into death with inquest 17/05/2012 Coroner Dr Jane Hendtlass
    Paul Flintoft COR 2007 4444 Finding into death with inquest 17/05/2012 Coroner Ian Watkins
    Osbournes COR 2010 1345 Finding into death with inquest 08/05/2012 State Coroner Judge Jennifer Coate
    Robert Stradling COR 2011 1652 Finding into death with inquest 07/05/2012 Coroner John Olle
    John Harwood COR 2011 0897 Finding into death with inquest 07/05/2012 Coroner John Olle
    Arthur Gavardinas COR 2010 3816 Finding into death without inquest 07/05/2012 Coroner Kim M. W. Parkinson
    Evelyn Wright COR 2011 3385 Finding into death with inquest 04/05/2012 Coroner Kim M. W. Parkinson
    Stuart Bullas COR 2011 1465 Finding into death without inquest 30/04/2012 Coroner John Olle
    Kenneth Agnew COR 2007 5107 Finding into death with inquest 30/04/2012 Coroner John Olle
    Dominique Cupsa COR 2009 0277 Finding into death with inquest 30/04/2012 Coroner Jacinta Heffey