North Carolina Breastfeeding Coalition Employers and Community Partners Award

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Business/Organization Name

Point of Contact Name

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Business Street Address

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Business website/URL

Number of Employees

1-10

11-20

21-50

51-100

101-200

201-300

300+

Hourly Employees

Salaried Employees

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The Community Partner award is for organizations that support chestfeeding/breastfeeding customers or patrons.

The Employer Award is for businesses that support lactating staff members.

Organizations/Businesses may apply for both or just one. Please select all that apply for your business.

We are applying for the Community Partner Award only.

We are applying for the Employer Award only.

We are applying for both awards.

For the Community Partner (to support chestfeeding/breastfeeding customers or patrons), please select all supportive practices that apply:

Required for Award: Breastfeeding/chestfeeding families are always welcome and respected. They will never be treated poorly, asked to stop feeding, or asked to cover up or move.

Required for Award: We do not advertise infant formula or related products directly to consumers.

Required for Award: We support all breastfeeding, chestfeeding, and human milk feeding families inclusive of their race, ethnicity, immigration status, nationality, creed, age, sexual orientation, gender identity, family structure, primary language, ability, or class.

Optional/Recommended: Our staff are educated on the rights and needs of chestfeeding/breastfeeding families.

For the Employer Award (to support lactating/breastfeeding employees), please select all supportive practices that apply:

Required for Award: All lactating employees are allowed breaks to express milk or nurse their children.

Required for Award: All lactating employees have access to a private space for expressing milk or nursing. The space is not a bathroom. The space is shielded from view and free from intrusion by co-workers and the public. The space has an electrical outlet and hand hygiene station.

Required for Award: We have a written lactation support policy, and orient our staff to its principles to ensure awareness of worksite support for lactation. (Link to a sample policy: https://breastfeedorangenc.org/app/uploads/2023/11/Employee-Lactation-Policy-Template_112023.pdf)

Required for Award: We do not advertise infant formula or related products directly to consumers.

Optional/Recommended: The space is lockable.

Optional/Recommended: Staff have access to a refrigerator for milk storage.

Optional/Recommended: We offer flexible return-to-work policy (part-time, job sharing, telecommunicating, flex time, etc.)

Optional/Recommended: We have taken extra steps to make the lactation space warm and welcoming by doing any of the following: comfortable chair, pictures of babies / space to post pictures of babies, music / sound player, electric pump (employees bring their own kits), wall clock, notebook for employees to write to each other, etc.

How would you like to celebrate your award?

Receive the award and cling(s) in the mail.

Add our business to the list of awardees on the NCBC website. (https://www.ncbfc.org/)

Does this organization have more than one location you would like recognized?

Yes

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If yes, please list all other locations:

Thank you for applying. We currently review applications in February and July of each year. Awards reviewed in February are given in March, and awards reviewed in July are given in August. Please use this space to enter any questions or comments.

A copy of your responses will be emailed to the address you provided.

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