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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. Anyone 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
    Maria Teresa Nigro COR 2009 0829 Finding into death with inquest 02/04/2015 Coroner Audrey Jamieson
    John Christopher Hender COR 2006 0950 Finding into death with inquest 05/06/2013 Coroner Dr Jane Hendtlass
    Dianne Chi COR 2015 0999 Finding into death with inquest 01/04/2016 State Coroner Judge Sara Hinchey
    Nina Solyk COR 2008 1047 Finding into death with inquest 08/09/2010 Coroner Dr Jane Hendtlass
    Michelle Johnson COR 2010 1093 Finding into death with inquest 21/03/2014 Coroner Phillip Byrne
    Shane Bennett COR 2008 1132 Finding into death with inquest 23/03/2012 Coroner Peter White
    Scarlet Ryle Spain COR 2012 1250 Finding into death with inquest 18/04/2013 Coroner Kim M. W. Parkinson
    Ronald James Cruse COR 2010 1282 Finding into death with inquest 20/05/2011 Coroner Jonathan G Klestadt
    Michael Cleary COR 2011 1348 Finding into death with inquest 04/06/2012 Coroner Kim M. W. Parkinson
    Gethin Roberts COR 2004 1420 Finding into death with inquest 06/05/2005 Coroner Phillip Byrne