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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 Sort descending Case type Date Coroner Related orders and rulings Responses to recommendations
    Joan Hendrickson COR 2006 1884 Finding into death with inquest 08/09/2010 Coroner John Olle
    Jason David Jenkins COR 2006 2181 Finding into death with inquest 15/10/2010 State Coroner Judge Jennifer Coate
    Trevor Ronald McDonald COR 2006 2298 Finding into death with inquest 01/10/2012 Coroner Dr Jane Hendtlass
    Adam Michael Francis Fabre COR 2006 2614 Finding into death with inquest 24/03/2010 State Coroner Judge Jennifer Coate
    Stuart Judd COR 2006 2840 Finding into death with inquest 17/03/2011 Coroner F Hayes
    Brodie Panlock COR 2006 3625 Finding into death with inquest 16/05/2008 Coroner Peter White
    Cara Grace Zambelli COR 2006 3652 Finding into death with inquest 11/07/2011 Coroner Audrey Jamieson
    Leigh Sarah Sinclair COR 2006 3727 Finding into death with inquest 29/09/2009 Coroner Peter White
    Christopher Alan Giorgi COR 2006 3728 Finding into death with inquest 29/09/2009 Coroner Peter White
    Lydia Denise Carter COR 2006 3796 Finding into death with inquest 22/03/2012 Coroner Heather Spooner