Michigan Breastfeeding-Friendly Workplace Awards Application Survey

We welcome employers who create a supportive environment for lactating employees - and go above and beyond the requirement of the PUMP for Nursing Mothers Act - to apply for recognition! Please note that there is a $15 donation requested for each award, we process applications monthly, and each award is for 1 calendar year. Please spread the word and submit your application today!

Thanks for all you do to build a more just, equitable, and breastfeeding-supportive workplace culture.

If you have any questions, please email hello@mibreastfeeding.org.

Question Title

Contact Information

Applicant's Full Name

Email Address

Phone Number

Question Title

Workplace Information

Workplace Name *

Address *

City/Town, Michigan *

County

ZIP/Postal Code *

Workplace Website *

Workplace Facebook Page *

Question Title

Is your employer part of a larger company with more than one location in Michigan?

Yes

Application Criteria:
Award level will be determined based on this criteria and checklist.

Application Checklist:
Please check all the boxes that apply to your workplace.

Question Title

Policy and Education

Written agreement between employee and direct supervisor regarding break times and space to express milk

Written breastfeeding policy

Written and verbal information provided to all employees about breastfeeding support as part of employee handbook, training, and/or in-services

Breastfeeding-supportive education provided for all employees

Question Title

Scheduling

Ability to work part-time or some hours from home

Flextime or job-sharing option

On-site childcare

"Baby-at-work" program

Paid family leave

Breast pump provided or subsidized by employer or included as part of company-provided insurance policy

Question Title

Resources

Up-to-date list of local breastfeeding resources provided to all pregnant employees

Lactation support services provided for employees (via insurance or paid by employer)

Question Title

BONUS- Facilities (each is worth 1/2 of a point toward your total)

Comfortable chair for pumping/nursing

Small table

Electrical outlet

Refrigerator or personal cooler for milk storage

Nearby sink with running water or sanitizing wipes for clean-up

Wi-Fi access

Question Title

In 1-2 sentences, what would you like us to know about your employer's support of breastfeeding employees?

Question Title

I'm granting permission for MIBFN to use my answer to Question 8 as a quote in our website, reporting, social media, etc.

Yes

Question Title

Please note that there is a $15 donation requested for each award, we process applications monthly, and each award is for 1 calendar year. I have submitted this amount at mibreastfeeding.org/awards under "Awards Applications Payment."

I have submitted payment

Thank You For Catalyzing A Race To The Top Amongst Breastfeeding-Friendly Employers Throughout Michigan!
Additional resources and tools can be found at www.mibreastfeeding.org/workplace