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 |
---|---|---|---|---|---|---|
Daniel Charles Richards | COR 2019 003231 | Finding into death with inquest | 08/12/2021 | State Coroner Judge John Cain | ||
Eden Herbert-Allan | COR 2018 003944 | Finding into death without inquest | 06/12/2021 | Coroner Audrey Jamieson | ||
Ingeburg Hildegard Muller | COR 2018 004310 | Finding into death without inquest | 06/12/2021 | Coroner Audrey Jamieson | ||
Eileen Violet Smith | COR 2019 004989 | Finding into death without inquest | 30/11/2021 | Coroner Leveasque Peterson | Mildura Base Hospital was required to respond by 1/03/2022. No response has been received to date. |
|
Felicity Ruth Loveday | COR 2021 0282 | Finding into death with inquest | 29/11/2021 | Coroner Audrey Jamieson | ||
Adrian Christian Victor Meneveau | COR 2021 0279 | Finding into death with inquest | 29/11/2021 | Coroner Audrey Jamieson | ||
Daniel Neil Thomas | COR 2017 001402 | Finding into death with inquest | 25/11/2021 | Coroner Katherine Lorenz | ||
Raylene Barbara Armstrong | COR 2019 0657 | Finding into death without inquest | 25/11/2021 | Coroner David Ryan | ||
Nicholas Lopes | COR 2020 000831 | Finding into death with inquest | 24/11/2021 | Coroner Katherine Lorenz | ||
Mark Leslie Missen | COR 2016 001154 | Finding into death without inquest | 24/11/2021 | State Coroner Judge John Cain |