Skip to main content Skip to home page

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 Sort descending Date Coroner Related orders and rulings Responses to recommendations
    Callie Griffiths-I'Anson COR 2018 002701 Finding into death with inquest 03/07/2023 Deputy State Coroner Paresa Spanos
    Sarah Lavinia Simpson COR 2012 0400 Finding into death with inquest 11/12/2014 Coroner Jacinta Heffey
    Nicola Jane Stephens COR 2018 006287 Finding into death with inquest 12/09/2023 State Coroner Judge John Cain
    Irene Mary Donne COR 2020 002367 Finding into death with inquest 11/04/2024 State Coroner Judge John Cain
    Carl Ranthe COR 2009 0013 Finding into death with inquest 28/02/2011 Coroner John Olle
    Drew William Ritchie COR 2006 0222 Finding into death with inquest 18/06/2010 Deputy State Coroner Paresa Spanos
    Stuart Hill COR 2008 0333 Finding into death with inquest 05/10/2011 Coroner Peter White
    COR 2012 0400 Finding into death with inquest 11/12/2014 Coroner Jacinta Heffey
    Darcey Iris COR 2009 0447 Finding into death with inquest 30/10/2015 State Coroner Judge Ian L Gray
    Paul Taylor COR 2011 0515 Finding into death with inquest 25/07/2011 Deputy State Coroner Iain West