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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
    Mohamed Ali Chaouk COR 2005 1152 Finding into death with inquest 23/04/2010 Deputy State Coroner Paresa Spanos
    Trevor James Day COR 2006 0303 Finding into death with inquest 27/04/2010 Coroner Audrey Jamieson
    Stuart Fraser Ronaldson COR 2007 0129 Finding into death with inquest 30/04/2010 Coroner John Olle
    Christian Gonzalo Diaz COR 2008 0145 Finding into death with inquest 03/05/2010 Coroner Audrey Jamieson
    Simon Mark Gray COR 2008 2648 Finding into death with inquest 06/05/2010 Coroner Kim M. W. Parkinson
    Ali Sultan Zaidi COR 2007 3771 Finding into death with inquest 19/05/2010 Coroner John Olle
    Beatrice Ivy Brown COR 2007 2165 Finding into death with inquest 19/05/2010 Coroner John Olle
    Eileen May Howell COR 2008 5801 Finding into death with inquest 20/05/2010 Deputy State Coroner Paresa Spanos
    Laurel Faith Howard COR 2008 5806 Finding into death with inquest 20/05/2010 Deputy State Coroner Paresa Spanos
    Dianne Rose Guthrie COR 2009 1412 Finding into death with inquest 21/05/2010 Coroner Kim M. W. Parkinson