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 filing 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