PFD report

Xuanze Piao · Prevention of Future Deaths report

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Issued 11 Nov 2020•Coventry

Report record

Published report and response evidence

This page connects the concerns raised in this report with statements found in recipients’ published responses. A link shows a clear evidence connection; it does not assign responsibility.

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Concerns
2

Raised in this report

Recipients
1

Named on the report

Responses found
1

Of 1 recipient

Stated actions
3

Described in responses

Recipients and published responses

Source document

Full report text

This is the full text from the original published report.

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Concerns and recipient responses

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Report evidence summary

Concerns raised2

  1. Lack of a procedure for contacting an overseas student under 18’s Guardian or Parents when no face-to-face meeting has occurred before sending a course-removal risk email
  2. Lack of a procedure for a face-to-face meeting with an overseas student under 18 before sending an email indicating risk of removal from the course
    Part of recurring concern: Unreliable communication of significant academic decisions and support actions to students
Responses linked to these concerns

Each statement is shown once, even when linked to more than one concern.

Actions described in response An action is something a recipient says it has done, is doing, or plans to do in response to a concern raised.3

  1. Action

    Review policies and procedures for students under 18.

    Stated by Coventry UniversityStated in progressThe respondent said that this action was in progress when they made their response on 23 December 2020.
  2. Action

    Implement an additional process requiring welfare assessment meetings before withdrawing under-18 international students at visa-related engagement risk.

    Stated by Coventry UniversityStated completedThe respondent said that this action was complete when they made their response on 23 December 2020.
  3. Action

    Provide the finalized new under-18 student policy to the Coroner.

    Stated by Coventry UniversityStated plannedThe respondent said that this action was planned when they made their response on 23 December 2020.

Respondent positions A position is what a recipient says about a concern when it does not describe a specific action.1

  1. Position

    Existing attendance, engagement and welfare policies already provide face-to-face meetings and welfare checks and were followed.

    Stated by Coventry UniversityExisting arrangements considered sufficientThe respondent said that existing arrangements were sufficient, so no further action was needed.

Source evidence

How this individual concern was interpreted

PFD Monitor created a concise, searchable interpretation from the report wording shown below. Response links show a clear evidence connection; they do not assign responsibility.

PFD Monitor interpretation

Lack of a procedure for contacting an overseas student under 18’s Guardian or Parents when no face-to-face meeting has occurred before sending a course-removal risk email

Wider context from the report

“(.1) The University did not have a face to face meeting with Xuanze, a student under the age of 18, prior to sending him the email dated 29/11/2018 indicating that he was at risk of being removed from the course and that he should attend a meeting to discuss this on 03/12/2018; (.2) In the absence of a face to face meeting with Xuanze, the University did not contact either Xuanze’s Guardian or Parents prior to sending Xuanze the email dated 29/11/2018 indicating that Xuanze was at risk of being removed from the course and that he should attend a meeting to discuss this on 03/12/2018; Evidence was given at the inquest that in the case of an overseas student under 18, notwithstanding both prolonged absence from academic commitments and a persistent omission to respond to email requests that the absentee student should make contact with the university, there was no procedure or policy in place either for a face to face meeting with the student or, in the absence of such a face to face meeting, for contacting that student’s Guardian or Parents, prior to the email being sent indicating that the U.18 student was at risk of being removed from the course and that he should attend a meeting to discuss this. ”

Is this part of a recurring concern?

No recurring-concern membership is currently published.

Open source report

Source evidence

How this individual concern was interpreted

PFD Monitor created a concise, searchable interpretation from the report wording shown below. Response links show a clear evidence connection; they do not assign responsibility.

PFD Monitor interpretation

Lack of a procedure for a face-to-face meeting with an overseas student under 18 before sending an email indicating risk of removal from the course

Wider context from the report

“(.1) The University did not have a face to face meeting with Xuanze, a student under the age of 18, prior to sending him the email dated 29/11/2018 indicating that he was at risk of being removed from the course and that he should attend a meeting to discuss this on 03/12/2018; (.2) In the absence of a face to face meeting with Xuanze, the University did not contact either Xuanze’s Guardian or Parents prior to sending Xuanze the email dated 29/11/2018 indicating that Xuanze was at risk of being removed from the course and that he should attend a meeting to discuss this on 03/12/2018; Evidence was given at the inquest that in the case of an overseas student under 18, notwithstanding both prolonged absence from academic commitments and a persistent omission to respond to email requests that the absentee student should make contact with the university, there was no procedure or policy in place either for a face to face meeting with the student or, in the absence of such a face to face meeting, for contacting that student’s Guardian or Parents, prior to the email being sent indicating that the U.18 student was at risk of being removed from the course and that he should attend a meeting to discuss this. ”

Is this part of a recurring concern?

Yes — Unreliable communication of significant academic decisions and support actions to students.

Open source report

Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation

Review policies and procedures for students under 18.

Verbatim wording from the response

“The University is undertaking a full review of its policy and procedures relating to students who are under the age of 18. This is expected to be complete by 31 January 2021. The University will provide a copy of the new policy to the Coroner when it has been finalised.”

Source location

2020-0230-Response-from-Coventry-University.pdf
Page 2 · response
Published 23 December 2020

Open published response

Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation

Implement an additional process requiring welfare assessment meetings before withdrawing under-18 international students at visa-related engagement risk.

Verbatim wording from the response

“In relation to the concerns raised by the Coroner, the University refers to the chronology set out above. The University also confirms that it has already put in place an additional process for responding when international students who are under 18 fail to engage with their course where”

Source location

2020-0230-Response-from-Coventry-University.pdf
Page 2 · response
Published 23 December 2020

Open published response

Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation

Provide the finalized new under-18 student policy to the Coroner.

Verbatim wording from the response

“The University is undertaking a full review of its policy and procedures relating to students who are under the age of 18. This is expected to be complete by 31 January 2021. The University will provide a copy of the new policy to the Coroner when it has been finalised.”

Source location

2020-0230-Response-from-Coventry-University.pdf
Page 2 · response
Published 23 December 2020

Open published response

Source evidence

How this respondent position was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation

Existing attendance, engagement and welfare policies already provide face-to-face meetings and welfare checks and were followed.

Verbatim wording from the response

“The University’s attendance/engagement and welfare policies and procedures therefore already provide for face to face meetings and welfare checks and those policies and procedures were followed in this case. However, the University is committed to continuous evolution and welcomes any proposals, comments or suggestions about the development of its policies and procedures.”

Source location

2020-0230-Response-from-Coventry-University.pdf
Page 2 · response
Published 23 December 2020

Open published response
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Information checked against the published report and official responses · Data reviewed 7 Sep 2026 · About data quality and limitations

Official responses located
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Data last updated 7 September 2026