Workplace Breastfeeding Survey Order Number The Breastfeeding Coalition of Snohomish County would like to recognize companies in our county that provide breastfeeding support to their employees. Employers selected by a review committee will be awarded a certificate and credited in a press release to local media. Persons filling out this survey may remain anonymous if they wish. Submissions are due by June 30. 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, check all that apply. Our policy: Is in writing Is communicated to ALL employees Includes creative solutions to overcome specific workplace barriers (examples: babies allowed at work, or may be brought by other caregiver during breaks) Supports a breastfeeding friendly atmosphere through education of all staff 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. The space is: Available when needed Near my workspace Shared (ex: meeting room) PRIORITIZED for nursing mothers The space has a: Chair Table Electrical outlet Nearby sink / sanitizing wipes Refrigerator or cooler 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. Paid breaks Unpaid breaks Breaks are flexible and available whenever needed to express milk Please check all that apply. Company insurance provides 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 contacts) Education packet on benefits of breastfeeding Encouragement to take a breastfeeding class, see an IBCLC (lactation consultant) IBCLC services paid by employer or covered through employer health insurance Other Other (please explain) 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.
