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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
Angus William Wilson COR 2011 0958 Finding into death without inquest 08/12/2011 Coroner Jonathan G Klestadt
Linda Gale Cochrane COR 2011 1713 Finding into death with inquest 05/12/2011 Coroner Michael Patrick Coghlan
Garry John Stephens COR 2007 3546 Finding into death with inquest 02/12/2011 Deputy State Coroner Iain West
Peter Johnston COR 2009 5005 Finding into death with inquest 02/12/2011 Deputy State Coroner Iain West
Mark Ronald Connolly COR 2009 4013 Finding into death with inquest 02/12/2011 Deputy State Coroner Iain West
Tyler Di Blasi COR 2009 5545 Finding into death with inquest 01/12/2011 Coroner Kim M. W. Parkinson
David Mills Goodwin COR 2010 1255 Finding into death without inquest 30/11/2011 Coroner Stella Stuthridge
Ralph James McCracken COR 2011 1208 Finding into death with inquest 29/11/2011 Coroner Kim M. W. Parkinson
Tyler Cassidy COR 2008 5542 Finding into death with inquest 23/11/2011 State Coroner Judge Jennifer Coate
Tyler Cassidy COR 2008 5542 Finding into death with inquest 23/11/2011 State Coroner Judge Jennifer Coate