Note

Please download and save the PDF forms to your desktop to fill out.

Under the European Union (Basic Safety Standards for Protection Against Dangers Arising from Medical Exposure to Ionising Radiation) Regulations 2018 and 2019, undertakings have responsibility to submit statutory notifications to HIQA.

You will be able to submit these notifications to HIQA using our online portal system, once you have declared to us as an undertaking. Please complete the NF200 to make this declaration and submit the completed form to registration@hiqa.ie. This form is available by clicking on the link below.

  • NF200

    Declaration of undertaking
    This form should be used by a provider to declare to HIQA as an undertaking for medical exposure to ionising radiation.

    Timeframe Submit 1 month prior to commencing practice.
    NF200-Declaration-of-Undertaking.pdf323.45 KB

If you wish to make a change to the information you have previously supplied to us, please select the appropriate form from the options listed below.

Where possible, please use the online portal system to submit your form. Alternatively you may email the editable PDF form to registration@hiqa.ie. If using this method, please download and save the form before filling in your details. It is important to remember to save your form again before submitting to HIQA.

Please note, if a change of an undertaking’s details results in a change to its legal entity, the existing undertaking will need to complete a cessation of undertaking practice form (NF202A) and the new legal entity will need to declare as a new undertaking (NF200).

If you wish to submit a notification of a significant event to HIQA, please select the appropriate form from the options listed below. Examples of which form to use are given. Where possible, please use the online portal system to submit your notification. Alternatively you may email the editable PDF form to radiationprotection@hiqa.ie. If using this method, please download and save the form before filling in your details. It is important to remember to save your form again before submitting to HIQA.

For information on submitting a significant event please see HIQA’s Guidance on statutory notifications for accidental or unintended medical exposures to ionising radiation.

  • NF211A

    Accidental or unintended exposure to ionising radiation; Dental, Radiology, or Nuclear Medicine
    This form should be used to notify HIQA of a reportable accidental or unintended exposure to ionising radiation which occurred in relation to a Dental, Radiology, or Nuclear Medicine procedure.
    NF211A-Dental-Radiology-or-Nuclear-Medicine.pdf233.48 KB
  • NF211B

    Accidental or unintended exposure to ionising radiation; Radiotherapy
    This form should be used to notify HIQA of a reportable accidental or unintended exposure to ionising radiation which occurred in relation to a Radiotherapy procedure.
    NF211B-Radiotherapy.pdf253.5 KB
  • NF211C

    Accidental or unintended exposure to ionising radiation; Other
    This form should be used to notify HIQA of a reportable accidental or unintended exposure to ionising radiation which occurred in relation to a procedure which was not a Dental, Radiology, Nuclear Medicine or Radiotherapy procedure.
    NF211C-Other.pdf301.47 KB