Breastfeeding-Friendly Worksite Nomination Form

Recognize your business as one of Northern Colorado’s Breastfeeding-Friendly Worksites. Supporting breastfeeding mothers in the work place is not only the law, but is one way for businesses to embrace wellness, impact health care costs, lower absenteeism and be seen as a family-friendly business for potential and current employees. Businesses of all sizes and types are encouraged to apply to share creative solutions to support breastfeeding mothers and employees.

Contact Information

Name of individual completing nomination (required)

E-mail (required)

Phone

Business Information

Business Name (required)

Address

Brief description of Business

Award Criteria

Please check all that apply



May we promote this business as a Breastfeeding Friendly Worksite?

Submit additional documentation to support the nomination, such as testimony from a breastfeeding employee or patron, photo(s) of lactation room(s), workplace policy for supporting breastfeeding, and staff education. You may submit the additional documentation by attaching with the submission of this form or mail to:

Mike Schwan, MS.RD.
Weld County Department of Public Health and Environment
1555 N. 17th Avenue
Greeley, CO 80631
970-304-6420 ext. 2343
E-mail: mschwan@weldgov.com