Lactation Friendly Workplace Recognition Program - Online Application

Step 1 of 3

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Site Information

Name of applicant*

First Last

Email address of applicant*

Enter Email Confirm Email

Phone number of applicant*

Business name*

Business address*

Street Address City State ZIP Code

County*

Site locations, if multiple

Business website

What industry do you identify with?*

Agriculture

Arts, Entertainment, Recreation

Child Care

Construction

Education

Finance or Insurance

Food Services/Accommodations

Government

Health Care

Information/Technology

Manufacturing/Warehouse

Public Administration

Real Estate or Rental

Retail

Social Assistance/Social Services

Transportation

Other

Estimate your total number of employees*

(including full time, part time, and contractors)

Please enter a number from 1 to 30000.

Please attach a copy of your Final Assessment with at least one box checked in each category (Policy, Time & Space) of the Lactation Friendly Certified column*

The Assessment began on step 1 on page https://www.cobfc.org/lactation-friendly-workplace-recognition-for-employers/ Also, please add the name of your business to the first part of the file name.

Accepted file types: docx, doc, pdf, Max. file size: 3 MB.

Policy

Does your policy include the following?*

You must check all in order to achieve certification.

Breast/chestfeeding employees receive adequate breaktime to express milk

Breast/chestfeeding employees have an accessible, clean, private space to express milk that is not a bathroom.

Does your policy include non-discrimination language (preferred but not required for certification)?*

Yes

Is your policy a corporate, site or municipal policy?*

Corporate

Site

Municipal

Other

When was your policy created (month/year)?*

Exact day of the month isn't required, month and date is great.

MM slash DD slash YYYY

Please attach your Lactation Policy*

This is from step 3 on the https://www.cobfc.org/lactation-friendly-workplace-recognition-for-employers/ page Also, please add the name of your business to the first part of the file name.

Accepted file types: docx, doc, pdf, Max. file size: 2 MB.

Does your Communications Plan include the following?*

You must check all in order to achieve certification.

Guidelines for lactation room use

How your policy is communicated to employees

How supervisors and managers are trained to respond to lactation accommodation requests

Please attach your Communications Plan*

Please add the name of your business to the first part of the file name, if possible.

Accepted file types: docx, doc, pdf, Max. file size: 2 MB.

Environment

Does your lactation space (designated or prioritized) meet the following requirements?*

You must check all in order to achieve certification.

Includes table, chair and access to electrical outlet

Is private and is not a bathroom

When was your lactation space created (year)?*

Who is the space accessible to (e.g. employees, public, contractors)?*

Please attach photos of your lactation space(s) or prioritized area*

You can paste multiple photos into 1 document or upload individual photos here.

Drop files here or

Accepted file types: docx, doc, pdf, jpg, jpeg, png, heic, Max. file size: 4 MB, Max. files: 6.

Other Details

Please indicate the number of window clings you would like for your workplace*

Please enter a number from 0 to 1000.

Name, attention to, and address (if different than noted under site information) for window clings to be mailed to

Renewal Details

Your recognition will expire in 5 years. Upon expiration, COBFC will notify your team via email about the need to reapply. Please provide 2-3 points of contact (name & email address) to receive this notification. Recommended contacts include the person applying, Human Resources, wellness team, general business inbox, etc.

Renewal Contact 1 Name*

Renewal Contact 1 Email*

Please check for typoes

Renewal Contact 2 Name*

Renewal Contact 2 Email*

Please check for typoes

Renewal Contact 3 Name

Renewal Contact 3 Email

Please check for typoes

Thank you for your efforts to support lactating employees. The Colorado Breastfeeding Coalition looks forward to reviewing your application! Please click submit to proceed.

Phone

This field is for validation purposes and should be left unchanged.

Please use the form below to submit your online application.

Lactation Friendly Workplace Recognition Application

Site Information

Policy

Environment

Other Details

Renewal Details

Lactation Friendly Workplace Recognition Program – Online Application

Please use the form below to submit your online application.

Lactation Friendly Workplace Recognition Application

Site Information

Policy

Environment

Other Details

Renewal Details