Follow the steps to successfully complete the IE HIQA NF211A form online.

1. Press the ‘Get Form’ button to access the form and open it for editing.
2. Begin by filling out the undertaking and medical radiological installation details. Input the name, address (including Eircode), email, and contact number for the undertaking. Additionally, complete the medical radiological installation name and its address where the incident occurred.
3. In Section 1, provide details about the significant event. Enter the exact location of the incident, the date and time of occurrence, and the date of discovery. Specify whether multiple service users were affected and include relevant details about them.
4. Describe the incident in brief, ensuring that no personally identifiable information is included in accordance with GDPR. Mention appropriate actions taken to prevent immediate recurrence and provide brief information regarding these actions.
5. Indicate the significant event category based on the provided options that best fits the incident.
6. Detail the type of procedure or treatment involved in the incident, selecting the applicable options from the list provided.
7. Complete Section 3 regarding Open Disclosure. Indicate whether the incident was considered clinically significant and if key people were informed.
8. In Section 4, note whether relevant stakeholders have been notified of the incident.
9. Document the findings of the investigation and corrective measures in Section 5, ensuring these are submitted within the next 120 calendar days.
10. In Section 6, declare that all information provided is accurate. Print your name, job title, and contact number, sign the document electronically, and include the date.
11. Finally, submit the completed form by email to radiationprotection@hiqa.ie or keep it available for printing or sharing as needed.

Complete the IE HIQA NF211A form online for efficient reporting of significant radiological events.