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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
Rodney David Keegan COR 2011 2543 Finding into death with inquest 10/10/2012 Coroner Audrey Jamieson
SG COR 2012 0047 Finding into death without inquest 09/10/2012 Coroner David Bruce Sidney Cottrill
Sue Hui Wang COR 2010 3650 Finding into death with inquest 09/10/2012 Coroner Heather Spooner
Li Zhen Gao COR 2010 3649 Finding into death with inquest 09/10/2012 Coroner Heather Spooner
John Shane Cross COR 2010 4553 Finding into death with inquest 05/10/2012 Coroner John Martin Murphy
Trevor Ronald McDonald COR 2006 2298 Finding into death with inquest 01/10/2012 Coroner Dr Jane Hendtlass
Damien Perceval COR 2009 2063 Finding into death with inquest 28/09/2012 Coroner Kim M. W. Parkinson
CIE COR 2010 0038 Finding into death without inquest 28/09/2012 Coroner Audrey Jamieson
Holly Bridget Marion South COR 2007 0595 Finding into death with inquest 26/09/2012 Coroner Kim M. W. Parkinson
Timothy Casey COR 2008 1277 Finding into death with inquest 21/09/2012 Coroner Peter White