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
    Bartosz Zgadzaj COR 2017 5993 Finding into death with inquest 07/08/2019 Coroner Audrey Jamieson
    Matt Robert Crampton COR 2016 0678 Finding into death with inquest 03/09/2019 Coroner Darren Bracken
    Robb Thomas Lawson COR 2017 6361 Finding into death with inquest 28/02/2020 Deputy State Coroner Paresa Spanos
    Joelene Therese Dowden COR 2017 3353 Finding into death with inquest 01/05/2020 State Coroner Judge John Cain
    Pierino Taranto COR 2017 5776 Finding into death with inquest 19/06/2020 Coroner Jacqui Hawkins
    Kathleen Gladwyn Downes COR 1997 3954 Finding into death with inquest 27/03/2015 State Coroner Judge Ian L Gray
    Reece Richard D'Antonio COR 2018 4516 Finding into death with inquest 30/07/2020 Deputy State Coroner Caitlin English
    Zachary Matthew Bryant COR 2017 0343 Finding into death with inquest 19/11/2020 Coroner Jacqui Hawkins
    Matthew Glenister Blake Clark COR 2018 4649 Finding into death with inquest 15/12/2020 Coroner Sarah Gebert
    Anson COR 2016 3441 Finding into death with inquest 31/03/2021 Deputy State Coroner Paresa Spanos