Breastfeeding Friendly Employer Award Application
If you have questions about this application, please email
  • - -
  • YES NO
    Written breastfeeding support policy
    Verbal agreement between employee mother and her direct supervisior regarding her break times and space to pump
    Private area to pump other than a bathroom
    Flexible break adequate for 15-20 pumping time
    Education about policy provided to all employees
    Comfortable chair for pumping and/or nursing
    Small table provided in private room for pumping
    Electrical outlet provided in private room for pumping
    Refrigerator provided for breastmilk storage
    Sink with running water provided for clean up after pumping
    Paid maternity leave (6 weeks)
    Educational packet about breastfeeding given to all expectant parents
    Breast pump provided by employer
    Wall clock in pumping room
    Radio/CD player in pumping room
    Telephone in pumping room
    Breastfeeding wall art in pumping room
    Ability for breastfeeding employees to work part-time or some hours from home
    Flextime offered
    Job-sharing offered
    Onsite childcare
    Maternity leave available for up to 12 weeks (6 weeks Paid)
    Lending Library of Breastfeeding Resources
    List of regional breastfeeding resources
    Lactation consultant services provided for employees (via insurance or paid by employer)
  • Thank you for your application and for supporting the breastfeeding mothers in your employment. Please click the SUBMIT button after completion of this form.

    You will receive an email from the Business Case for Breastfeeding Committee within 2 weeks.
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