Ministry of Community Safety and Correctional Services :: Coroner

The Office of the Chief Coroner Logo

Death Investigations

Office of the Chief Coroner

Publications & Reports

Copies of reports not available online can be obtained by contacting the Office of the Chief Coroner at 416-314-4000, 1-877-991-9959 or by email at

April 2015 - Strategic Plan for Ontario’s Death Investigation System, 2015-2020

July 2013 - Review of Ornge Air Ambulance Transport Related Deaths

2011 - Investigation in to the Deaths of Four Residents of a Toronto Retirement Home

2011 - Death Review of the Youth Suicides at the Pikangikum First Nation

2009 - Drowning Report

Pedestrian Death Review

2009 - 2011 Office of the Chief Coroner Annual Report

  • 2005-2008 - available on request

2012 Patient Safety Review Committee Report

2012 Reports of the Geriatric and Long Term Care Review Committee

2013 - 2014 Reports of the Maternal and Perinatal Death Review Committee

2012 Report on Inquests

2014 Report of the Paediatric Death Review Committee and Deaths Under Five Committee

2012 Domestic Violence Death Reviews: Case Reviews of Domestic Violence Deaths