Department of Labor and Industry

QER

Forms

Insurance Compliance / Quarterly Expenditure Reports

General QER Instructions (pdf)

QER Form (pdf)

Surcharge Remittal Form (Form is for FY2014) (pdf)

Other Forms

Physician's Referral to Domiciliary Care (word)

Hospital Rate Change Form

Subsequent Injury Fund Application (pdf)

Memorandum of Agreement - Sample (pdf)