Application for Recognition as a Breastfeeding Friendly Workplace

The Minnesota Department of Health recognizes workplaces as Breastfeeding Friendly if they meet the criteria outlined below.

To apply, complete the fields below and upload supporting documents. You can complete the application all at once, or use the Save & Return feature below to get the URL so that you can return and work on it later.

Applications may be submitted at any time but are only reviewed four time annually. Applications are due by March 15, June 15, September 15, and December 15th for review by the end of the following month.

Contact

health.BFW@state.mn.us

with any questions.

Name of Employer

Number of Employees

Approximate percentage of employees who are women ages 15-44

Employer Address

City

State

ZIP Code

County

Name of Contact Person

Contact Person Title/Position

Contact Person Email

Contact Person Phone Number

My workplace has a written policy or guideline that addresses the elements of support, time, education, and place outlined below.

Yes

reset

Upload a copy of the policy or guideline.

Upload file

Information about the breastfeeding policy and workplace lactation support is provided to employees at the time they request maternity leave.

Yes

reset

My workplace provides opportunities for breastfeeding mothers to receive support and encouragement.
Examples include message boards in the lactation room, internal workplace support groups, information about your local breastfeeding coalition, or a list of support opportunities available in your community.

Yes

reset

Optional: Upload a list of local breastfeeding resources (local La Leche League chapter, lactation consultants, breastfeeding coalition, support groups) that is provided to pregnant and breastfeeding employees seeking breastfeeding information and support.

Upload file

My employer provides work schedule and work pattern flexibility to accommodate reasonable break times for breastfeeding employees to express breast milk or breastfeed as needed, for one year or longer after the child's birth. Written policy or guideline should reflect this. This is required by state and federal law.

Yes

reset

How do you ensure that all employees are familiar with the breastfeeding policy? How are supervisors trained to support breastfeeding? Describe.
Max 2500 characters.

Expand

Place

To be recognized as a Breastfeeding Friendly Workplace, employers must provide an appropriate number of lactation spaces relative to the number of breastfeeding employees.*

Each lactation space must:
--Be in an accessible location, within 5 minutes or less of the breastfeeding employees' workstations
--Be a private space, other than a bathroom, that is shielded from view and free from intrusion by coworkers and the public. A locking door is ideal. If a locking door is not provided, please explain how you ensure privacy. (State & federal law)
--Include access to an electrical outlet. (State law)
--Include a comfortable chair
--Include a small table or surface to support pumping equipment
--Have or be located near clean refrigerator space for milk storage
--Have or be located near a place to wash hands and clean pump equipment

Describe the location(s) available at your workplace for breastfeeding women to express milk while at work. Address the proximity of workstations to lactation spaces, presence of an electrical outlet, furniture provided, access to fridge space, access to a sink, and how privacy is ensured.
Max 2500 characters.

Expand

If your employees travel for work, describe how you ensure access to a clean, private place for mothers to pump while traveling. For example, if employees travel to areas without appropriate accommodations, one solution would be to create a travel kit which could include a privacy screen for car windows, a universal lock for a door, and sanitary wipes.
Max 2500 characters.

Expand

Photograph of lactation space

* must provide value

Upload file

Photograph of lactation space

Upload file

Photograph of lactation space

Upload file

*The appropriate number of lactation rooms depends on the size of the company, the number of female employees of childbearing age, and the number of buildings on campus, among other factors. Multiple sites should be provided if it will take breastfeeding employees more than 5 minutes to walk from their workstation to the lactation room. Companies with many female employees may wish to create lactation "suites," installing partitions or curtains in the lactation room to accommodate multiple users at one time.

Where did you hear about the Breastfeeding Friendly Recognition Program?

Date

M-D-Y

You have selected an option that triggers this survey to end right now.

To save your responses and end the survey, click the 'End Survey' button below. If you have selected the wrong option by accident and/or wish to return to the survey, click the 'Return and Edit Response' button.

Application for Recognition as a Breastfeeding Friendly Workplace

health.BFW@state.mn.us

Employer Information

Contact Person

Policy or Guideline

Support

Time

Education

Place

You have selected an option that triggers this survey to end right now.