Application for Recognition as a
Breastfeeding Friendly Health Department:
Steps 1 & 2
To apply for completion of Steps 1 & 2:
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 1: Establish a designated individual/group to manage the following tasks
including policy review, development, staff orientation and education
A. Establish a process for developing, reviewing and modifying policies, procedures and protocols related to
breastfeeding practice and environments
List the positions of individuals designated to
manage breastfeeding-related policy development
and review, staff orientation, and continuing
education related to the breastfeeding policy
Attach or provide a link to your health department's
document renewal procedure
B. Ensure staff receive orientation and continuing education on breastfeeding policy implementation and support
Attach orientation checklist or other appropriate documents
C. Complete assessment of community needs for individual breastfeeding promotion and support
Attach assessment of community needs for individual breastfeeding promotion and support (completed
within the last five years)
D. Initiate a breastfeeding coalition/taskforce with community and health department membership
Attach agenda or minutes from most recent meeting to email upon submission
Step 2: Have a written breastfeeding policy that is routinely reviewed with department
staff and meets the following criteria including addressing all BFHD 10 steps
A. The public health department has a written policy that addresses all ten steps
Attach policy
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The health department breastfeeding policy:
B. Indicates all mothers will be referred to appropriate individual support within the community
C. Identifies first point of referral in healthcare provider/ community for mothers experiencing common
breastfeeding challenges
D. Includes language about support for breastfeeding employees in accordance with state statutes
E. Includes language about support for breastfeeding employees in accordance with state statutes
Office Use:
Received on
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
Filed on
Site ID