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Breastfeeding, Chestfeeding and Lactation Friendly Worksite Designation Assessment Form

The Erie County Department of Health (ECDOH) is committed to promoting and protecting a mother’s right to breastfeed her child for as long as she chooses. Doctors recommend exclusive breastfeeding for at least six (6) months for the optimal health of a mother and her child. New York State Labor Law (Section 206-c) requires employers to provide reasonable time for an employee to express milk during the work period as well as private space (not a restroom or toilet stall) that is free from intrusion by co-workers and the public. These provisions must be accommodated for up to three years after the birth of the child.

Worksite Information

Please complete the following to be considered for the Breastfeeding Friendly Workplace Designation and/or to receive technical assistance.

Company Name
Company Address
Contact Name

Workplace Policy

Check all that apply

Breastfeeding Facility

Check all that apply

Breastfeeding Resources

Check all that apply

Breastfeeding Insurance Benefits

Check all that apply

Technical Assistance