Workplace Breastfeeding Awards - 2018 El formulario de nominación también está disponible en español. Printable forms are also available in English and Spanish. Company The Breastfeeding Coalition of Snohomish County would like to recognize companies in our county that provide breastfeeding support to their employees. Employers nominated and selected by a review committee will be honored as part of World Breastfeeding Week in August. Persons filling out application may remain anonymous if they wish. Nominations are due by July 4. I have experience with breastfeeding support from this employer: * As a nursing or pregnant parent Due to my job responsibilities As a coworker Company Name: * Best way to contact company to present award: Phone Email Person/persons deserving special recognition for support (if applicable): POLICY Does your employer describe their breastfeeding support in a policy? * Yes No If yes, please check all that apply. Written policy Policy is communicated to ALL employees Policy includes creative solutions to overcome specific workplace barriers (examples: babies allowed at work, or may be brought by other caregiver during breaks) Policy supports a breastfeeding friendly atmosphere through education of all staff Policy supports breastfeeding for as long as parent desires (not just one year) Other Other (please explain) LOCATION Does your employer provide a non-bathroom, private, secure location to express milk? * Yes No If yes, please check all that apply. Near my workspace Comfortable chair Small table Electrical outlet Refrigerator or cooler for milk storage Nearby sink with running water or available sanitizing wipes Space is aesthetically pleasing The space is available whenever it is needed The space is shared for other purposes (examples: storage closet, meeting room) The space is PRIORITIZED for nursing mothers Other LOGISTICS Does your employer offer the following options that support continued breastfeeding? Please check all that apply. Break time for expressing milk Please check all that apply. Breaks are paid Breaks are unpaid Breaks are flexible and available whenever needed to express milk Please check all that apply. Company insurance provides double-electric breast pump Employer provides multi-user pump at office/workplace Flexible work hours Ability to work part-time or return to work gradually Flextime, telecommuting, work-from-home options, or job sharing Maternity leave (not including sick, vacation, or disability pay) Please check all that apply. Paid Unpaid Length of maternity leave: Please check all that apply. Paternity leave Onsite childcare "Baby-at-work" program Other Other (please explain) COMMUNITY SUPPORT Which of the following does your employer provide to pregnant and breastfeeding employees? Please check all that apply. List of local breastfeeding services (breastfeeding groups, La Leche League meetings, IBCLC contact information) Education packet promoting the benefits of breastfeeding Encouragement to take a breastfeeding class, see an IBCLC (lactation consultant), or receive other high-quality support IBCLC services paid by employer or covered through employer health insurance Other Have you felt supported to continue breastfeeding by your: Coworkers Yes No Manager/Supervisor Yes No Do you have any additional comments about your experience with your employer regarding accessibility and friendliness towards breastfeeding? Thank you for taking the time to complete this questionnaire. The information you have provided will assist the Breastfeeding Coalition of Snohomish County in recognizing employers that support breastfeeding.
