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Coroner’s reportPrevention of future deaths · 2022-0003

“identified in paragraph 5”

Dated 5 Jan 2022, from the coroner for Gloucestershire. Sent to 3 organisations or people.

A coroner wrote this report after an inquest, to warn the organisations below about a risk of further deaths.

Read the full report on judiciary.uk

How this works

The 56-day response deadline

Deadline passed

Replies were due by 2 Mar 2022. A reply may have been sent and not yet published.

Organisations that receive a report must reply to the coroner within 56 days, saying what they will do or why they will do nothing. We show whether a response is published on judiciary.uk.

  1. Report dated5 Jan 2022
  2. Deadline2 Mar 2022
  3. Published on judiciary.uk10 Jan 2022
  4. Today23 Oct 2026

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Responses from each recipient

Responses from each recipient
Sent toResponse
British Diving Safety GroupResponse publishedPublished on judiciary.uk in January 2022.
University Hospitals Sussex NHS Foundation TrustResponse published, not yet matchedA response is published with this report. We haven’t yet matched it to the organisation it’s from, so it may be this one’s.
National Diving and Activity CentreResponse publishedPublished on judiciary.uk in January 2022.

The coroner’s concerns

identified in paragraph 5. Recipient (3) NDAC, to respond only on the third matter of concern identified in paragraph 5. I, the Coroner, may extend the period.

An extract. Read the full report, including the circumstances of the death, on the Courts and Tribunals Judiciary website.

Source
judiciary.uk, Prevention of Future Deaths reports, 2022-0003
Added to Minute Book
8 Oct 2026
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Contains public sector information licensed under the Open Government Licence v3.0. Source: Courts and Tribunals Judiciary, judiciary.uk. Open Government Licence v3.0

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