Infant Friendly Worksite Application

Fill out the application below to see if your organization has what it takes to be a designated Infant Friendly Worksite!

You can download a copy of a sample written policy for your business here.

* information is required

Worksite Name:*
Contact Name:*
Is this a corporate policy or impacting more than one location?:
If yes please list each location:
Flexible break time for expression of milk:*
A comfortable location allowing privacy for pumping (must not be a toilet stall or restroom):*
A convenient and safe water source and sink, near a private location, for washing hands and breastfeeding pumping equipment:*
A place for an employee to temporarily store breast milk (either a refrigerator or the employee can bring a small ice chest/cooler):*
A written policy that is communicated to all employees (please submit policy with application):*
Number of employees:*
How will you be informing employees about this policy change?:*
How did you become aware of the infant friendly worksite designation program? (Check all that apply):*
If approved for recognition as a North Dakota Infant Friendly Worksite, I grant permission to include the name of our worksite on this website.:*
Authorized business representative:*
Authorized business representative - title:*
Upload Written Policy:*
(DOC, PDF, and DOCX filetypes only)