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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 descending Coroner Related orders and rulings Responses to recommendations
Gethin Roberts COR 2004 1420 Finding into death with inquest 06/05/2005 Coroner Phillip Byrne
Christopher Robert Cowton COR 2005 1373 Finding into death with inquest 21/04/2006 Coroner Heather Spooner
Nicole Maree Knox-Smith COR 2004 1311 Finding into death with inquest 21/07/2006 State Coroner Graeme Johnstone
Tyson Owen Van Dillen COR 2005 0759 Finding into death with inquest 24/07/2006 Coroner Audrey Jamieson
Lee Andrew Kennedy COR 2005 1318 Finding into death with inquest 04/02/2008 Coroner Audrey Jamieson
Georgie Lopiccolo COR 2005 2579 Finding into death with inquest 20/02/2008 Coroner Paresa Spanos
Brodie Panlock COR 2006 3625 Finding into death with inquest 16/05/2008 Coroner Peter White
Kath Bergamin COR 2007 1111 Finding into death with inquest 04/06/2008 Coroner Peter White
Christopher Alan Giorgi COR 2006 3728 Finding into death with inquest 29/09/2009 Coroner Peter White
Leigh Sarah Sinclair COR 2006 3727 Finding into death with inquest 29/09/2009 Coroner Peter White