Application for Recognition as a
Breastfeeding Friendly Health Department:
Step 9
To apply for completion of Step 9:
Complete this form electronically using Adobe Acrobat or Adobe Reader 9.1 or later. Adobe Reader is a free
application that can be downloaded from the internet. Save the form to your computer and submit it by email as an
attachment to [email protected], along with any required supplemental documents (see below), a cover sheet,
and applications for the other steps your health department has completed. See the web page or the cover sheet for
more details about the application process.
Note: Any place you are asked to attach a document or enter text it is acceptable to provide a link to a current web
page instead. An attachment is also acceptable as an alternative to entering text directly on this form.
Step 9: Select businesses each year to provide workplace lactation support training
A. Discuss the benefits of breastfeeding for the workplace
Identify at least two
workplaces or business
organizations you have
worked with or are currently
working with
As part of your workplace lactation support training:
B. Provide a sample workplace breastfeeding policy
C. Provide minimum requirements of a lactation room
D. Provide sample materials to be included in an employee breastfeeding packet
Attach or provide link to resources used to provide education
to area businesses about workplace lactation support
E. Honor local breastfeeding friendly workplaces through community task force/coalition
Provide an example of how
you have honored at least
one local breastfeeding
friendly workplace or plan to
in the future. Photos
encouraged.
Office Use:
Minnesota Department of Health
Office of Statewide Health Improvement Initiatives
P.O. Box 64882, St. Paul MN 55164-0882
www.health.mn.state.us/divs/oshii
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