Workplace Self-Assessment Business Name * Email * Phone * (###) ### #### Contact Person First Name Last Name Policy An explicit policy or set of guidelines outlining organizational support for breastfeeding employees Progressing We do not have a breastfeeding policy/guideline. Our breastfeeding policy/guideline is informal and is not written or regularly communicated to staff. We have a written breastfeeding policy/guideline but it is not regularly communicated to all employees. Breastfeeding Friendly We have a written breastfeeding policy/guideline and it is communicated to all employees. Breastfeeding Advocate Breastfeeding policy/guideline-related information is provided to all new hires. Breastfeeding policy/guideline-related training is provided to all new managers. Our insurance plan covers breastfeeding equipment or breastfeeding services OR we educate our employees on breastfeeding-related benefits available through the Affordable Care Act. Our insurance plan notifies our employees that we are a breastfeeding-friendly workplace. We contract with a lactation consultant to provide services for all breastfeeding employees. Time Workplace flexibility Progressing There are significant barriers to mothers scheduling breaks and work patterns to provide time to breastfeed, express, or pump breastmilk during the workday. Breastfeeding Friendly There are few or no barriers to mothers scheduling breaks and work patterns to provide time to breastfeed, express, or pump breastmilk during the workday. Breastfeeding Advocate Employees can bring breastfeeding infants to work with them. Childcare is available and accessible to employees and accommodates breastfeeding. Space Accessible, clean, private, and safe space other than a bathroom for employees to express or pump breastmilk Progressing There are no designated breastfeeding rooms or areas available. Breastfeeding Friendly Prioritized breastfeeding room(s) are identified and can be used by employees as needed. Breastfeeding rooms are solely designated as breastfeeding room(s) for employees. Breastfeeding Advocate Refrigerator space is prioritized for breastmilk storage in proximity to the pumping space. A functioning sink is in proximity to the pumping space for employees to clean pumping equipment. Breastfeeding-friendly messaging and/or graphics are around the workplace We have electric breast pumps available for breastfeeding employees. We have pump kits available for breastfeeding employees. Thank you!