Nomination Criteria - My employer/workplace provides (please check all that apply):

A private space for employees to pump/express breast milk or nurse their babies

Flexibility for employees to bring young babies to work with them

Regular break times or a more flexible work schedule to facilitate pumping/nursing

Access to an electric breast pump

A refrigerator for storage of expressed breast milk, and sink area for cleaning equipment

Services of a lactation consultant

Information on workplace breastfeeding support services to all employees

Other - please specify:

Employer's Name and Address:

In addition, The Massachusetts Breastfeeding Coalition is interested in knowing if you have had any negative experiences with employers who are not supportive of your efforts to continue breastfeeding while at work. We will use this information in our efforts to educate the business and legislative community.

I had a negative breastfeeding experience at (name and address of employer):

because:

I returned to work when my baby was months old.

Your Name and Phone # (optional):

Email Address (optional):