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NEW HAMPSHIRE BREASTFEEDING TASK FORCE
BREASTFEEDING FRIENDLY EMPLOYER AWARD APPLICATION

** Required Fields












** Please check the option that best defines your worksite:
 
 
  		 
 
   
   
** How long has your lactation/breastfeeding support been in place?
 
  		 
 
** If selected as an award winner, would you be willing to serve as a resource for other employers?
   
** Award Criteria (Indicate all that apply)
a. A written breastfeeding policy that is provided to all employees
b. Provide a room with a lockable door (not a bathroom/toilet)
c. A comfortable chair for pumping or nursing baby
d. Flexible (paid or unpaid) breaks of at least 15-20 minutes every 2-3 hours and a lunch break
** Any or all additional breastfeeding support elements offered within the business:
a. Educational breastfeeding materials for all expectant parents
b. Refrigerator nearby for milk storage
c. Nearby sink
d. Electrical outlet
e. Small table or shelf
f. Radio/CD player
g. Breastfeeding artwork
h. Ability to work part-time or offsite
i. Flex time/ flex schedule offered
j. Job-sharing
k. On-site child care
l. List of regional breastfeeding supports provided and maintained
m. Lactation consultant services provided by employer's insurance or paid for by employer
n. Lending library with breastfeeding resources
o. Maternity leave available for at least 12 weeks
p. Paid family leave

Thank you for all your efforts and we look forward to reviewing your application.

Technical Assistance is available through our website at www.nhbreastfeedingtaskforce.org
or you can contact the Task Force at nhbreastfeeding@gmail.com
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