search iconlogin icon

Victorian Coroner’s Reports, Findings & Recommendations

SPASA Summary of Coroner's Court Reports relating to toddler (aged 0 - 4) drownings since 2000 in Victoria

Coroner Audrey Jamieson's report 'Finding Into Death Without Inquest' dated 1 May 2017 makes the following recommendations:

Coroner’s recommendations

SPASA Victoria’s view

1. With the aim of improving Victoria's pool safety regulation framework and preventing like deaths, I recommend that during the review of the Building Regulations 2006, the Minister for Planning consider adopting elements of the framework enacted in Queensland, including but not limited to, requiring that a pool safety certificate be obtained prior to a property with a pool being sold or leased.

SPASA supports this recommendation to improve swimming pool safety standards.

2. With the aim of improving Victoria's pool safety regulation framework and rigorously monitoring compliance, I recommend that, as anticipated in the recommendation made by Deputy State Coroner lain West in the Finding following the Inquest into the death of Lauren Kayley Harris dated 14 October 2014, the Minister for Planning consider the creation of a statewide pool register. SPASA supports this recommendation to improve swimming pool safety standards.
3. With the aim of emphasising and enhancing the role of real estate agency staff in detecting malfunctioning pool safety barriers in rental properties, I recommend that the Minister for Consumer Affairs, Gaming and Liquor consider that onsumer Affairs Victoria also produce a pro forma Routine Inspection Report document, which incorporates reference to 'pool fence and gate' and 'spa fence and gate', as in its condition report. SPASA supports this recommendation to improve swimming pool safety standards.


The 2012 Coroner’s Inquest into the death by drowning of Victorian toddler Lauren Harris made seventeen recommendations, all of which SPASA endorses. The following ten are particularly relevant to this discussion: 

Coroner’s recommendations

SPASA Victoria’s view

1. If the pool builder contracts with the property owner to only construct a swimming pool (and not also the pool safety barriers) then the responsibility to construct the mandatory safety barriers will be imposed on the owner.

SPASA supports this recommendation to improve swimming pool safety standards.

2. A clear obligation on the Building Permit holder to inform the relevant Building Surveyor when they have commenced building work.

SPASA supports this recommendation to improve swimming pool safety standards.

3. A mandatory obligation on the relevant Building Surveyor to inspect any swimming pool Building Permit site within 2 months of the relevant Building Permit lapsing.

SPASA supports this recommendation to improve swimming pool safety standards.

4.  Obligation on the relevant Building Surveyor to provide information on mandatory reporting and inspection obligations.

SPASA supports this recommendation to improve swimming pool safety standards.

5.  Municipal Building Surveyors should be able to issue infringement notices for breaches of the law in relation to swimming pools.

SPASA supports this recommendation to improve swimming pool safety standards.

6.  Authorised officers able to enter private properties for compliance with legislation and any Building Permit relating to a swimming pool.

SPASA supports this recommendation to improve swimming pool safety standards.

7.  Mandatory inspections of swimming pool safety barriers every three (3) years by licensed pool safety inspectors.

SPASA supports this recommendation for mandatory inspections, which would bring Victorian rules into line with most other Australian states.

8.   Certificates of compliance for pool safety barriers as pre-conditions to the sale or rental or house sitting of any property that has a swimming pool.

SPASA supports this recommendation to improve swimming pool safety standards.

9. Pool owners be required to self-register free of charge on a Statewide, online register and provide certification that their pool barrier complies with the legislation.

SPASA supports this recommendation as the means of establishing a mandatory swimming pool safety barrier inspection regime.

10. Parliament consider providing a single piece of legislation containing a uniform set of rules and requirements relating to the construction and fencing of pools, irrespective of their date of construction.

SPASA supports the concept of a single piece of legislation containing a uniform set of rules and requirements relating to the construction and fencing of pools.
SPASA suggests consultation around simplifying barrier rules, noting that it will be physically impossible for some older pool barriers to be modified. Blanket retrospective barrier regulation amendments will not be practically possible to implement.

 

The Evidence From Other States of Australia

Pool and spa barrier inspections are currently mandatory in three states - NSW, QLD and WA. Since the introduction of mandatory inspections in WA in 1992, there has been an 80% reduction in the rate of toddler drownings*. This Western Australia data proves that mandatory barrier inspection legislation works.
*8.7 deaths per 100,000 people in 1992 down to 1.66 deaths per 100,000 people in 2016 (Source: Royal Life Saving Society WA Inc)

Life Saving Victoria - Drowning Deaths of Children 0-4 years in Home Pools (2006/07 to 2015/16)

LSV Child Drowning Private Pools 2006 to 2015 2There were 13 drowning deaths of children aged 0-4 years of age in home swimming pools (and outdoor spas) in Victoria from 1 July 2006 to 30 June 2016 (See Figure 1 in article below).

All drowning deaths occurred on a weekday (one occurred on a public holiday), with nine occurring in the afternoon. The majority of deaths (eight) occurred in the summer and ten occurred in Greater Melbourne.

Similar to previous reports, coronial records indicate that the deaths primarily resulted from a combination of inadequate carer supervision immediately prior to the drowning, lack of adequate safety barriers between the child and the pool/spa and availability of an entry point.

Examples of inadequate safety barriers and available entry points include: safety barrier gate left propped open or door left open, faulty gate lock, safety barrier fence not maintained or adaptations to fence or surrounding area made so it no longer complied with the Australian Standards. There were also cases where a climbing point allowed access to the swimming pool.

Royal Life Saving National Drowning Report 2016 

Evidence That Victorian Pool Barriers Aren't Being Maintained

The Leader Newspaper article - Call for changes to Victorian Pool Fencing Laws - 28 November 2016

This investigation reveals the truth on pool and spa barrier compliance:

BOROONDARA: 24 pools inspected, zero compliance
DANDENONG: 22 pools inspected, zero compliance
FRANKSTON: No exact figures available but issues 40-55 non-compliance notes a year
GLEN EIRA: 195 pools inspected, more than 98 per cent failed to comply
HUME: 196 pools inspected, “at least 90 per cent” failed to comply
KINGSTON: Could not say how many inspections were made or how many pools complied
KNOX: 100 pools inspected, no figures provided but the “vast majority” failed to comply
MACEDON RANGES: No proactive pool inspection program and no figures available
MAROONDAH: 270 pools inspected in the past 18 months, 98 per cent failed to comply
MONASH: 151 pools inspected, only eight complied.
MOONEE VALLEY: 27 pools inspected, zero compliance
MORELAND: 130 pools inspected, “many” failed to comply
MORNINGTON PENINSULA: 261 pools inspected, zero compliance
NILLUMBIK: 75 pools inspected, 23 complied
STONNINGTON: 60 pools inspected, zero compliance
WHITEHORSE: 100 pools inspected, zero compliance
WHITTLESEA: 49 pools inspected, five complied
YARRA RANGES: 61 pools inspected, nine complied