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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
Vivianne May Rodger COR 2019 000309 Finding into death without inquest 10/01/2024 Coroner Paul Lawrie
Ya (Cindy) Zhao COR 2022 004111 Finding into death without inquest 09/01/2024 Coroner Simon McGregor
Vili Kovac COR 2021 003607 Finding into death without inquest 09/01/2024 Coroner Audrey Jamieson
John Anderson Mccormack COR 2023 001270 Finding into death without inquest 03/01/2024 State Coroner Judge John Cain
Lachlan McMahon Cook COR 2019 005395 Finding into death with inquest 20/12/2023 Coroner Audrey Jamieson
Jarryd Robert Liddicoat COR 2021 002178 Finding into death with inquest 20/12/2023 Coroner Kate Despot
John James Taylor COR 2021 003509 Finding into death without inquest 19/12/2023 Coroner Audrey Jamieson
QJW KUW OPW RCW COR 2021 006227 Finding into death without inquest 15/12/2023 Coroner David Ryan
Elly Rose Warren COR 2016 005474 Finding into death with inquest 15/12/2023 State Coroner Judge John Cain
Pennelope Shandelle Wilding COR 2022 006182 Finding into death without inquest 12/12/2023 Coroner Paul Lawrie