Get the free Nursing Mother Accommodation Request Form - Davis School District

Please submit this completed form to your supervisor. All information contained on this form is confidential to the extent permitted by law. ... Date. DSD May 2015.

How to fill out nursing mother accommodation request

How to fill out a nursing mother accommodation request:

1. Start by addressing the letter to the appropriate individual or department. Include their name, job title, and the complete address of the organization.
2. Begin the letter with a polite and professional salutation, such as "Dear [Recipient's Name]," or "To Whom It May Concern."
3. Clearly state the purpose of your letter in the first paragraph. Explain that you are a nursing mother and require accommodation in order to continue breastfeeding your child while at work or in your educational institution.
4. Provide a brief explanation of the specific accommodations you are requesting. This may include a private, clean, and comfortable space where you can express milk or nurse your baby, access to a refrigerator or storage area for expressed breast milk, flexible break times, or any other necessary accommodations.
5. Support your request with relevant information or documentation, such as a doctor's note or lactation consultant's recommendation, if available. This can help strengthen your case and demonstrate the legitimacy of your request.
6. Be clear about why these accommodations are important and how they will benefit both you and the organization. Highlight the positive impact accommodating nursing mothers can have on employee retention, productivity, and the overall well-being of parents and their babies.
7. Express your willingness to discuss further details or negotiate accommodations if needed. Provide your contact information, including your full name, phone number, and email address, so that the reader can easily reach out to you.
8. Close the letter with a courteous sign-off, such as "Thank you for considering my request" or "I appreciate your attention to this matter."
9. Attach any supporting documents or evidence that may be required, such as medical certifications or employer policies regarding breastfeeding and lactation accommodations.

Who needs a nursing mother accommodation request?

1. Working mothers who are currently breastfeeding or expressing milk for their babies.
2. Students or educators who are nursing mothers and require accommodations at educational institutions.
3. Any individual who is responsible for the care and nourishment of an infant or young child and needs assistance to continue breastfeeding while fulfilling their responsibilities at work or school.

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What is nursing mother accommodation request?

Nursing mother accommodation request is a formal request made by a breastfeeding mother to her employer for accommodations to express breast milk at work.

Who is required to file nursing mother accommodation request?

Any employee who is a nursing mother and needs accommodations to express breast milk at work is required to file a nursing mother accommodation request.

How to fill out nursing mother accommodation request?

To fill out a nursing mother accommodation request, the employee should provide their personal information, details of their breastfeeding needs, proposed accommodations, and any supporting documentation if required.

What is the purpose of nursing mother accommodation request?

The purpose of nursing mother accommodation request is to ensure that breastfeeding mothers are provided with the necessary accommodations and support to express breast milk at work in compliance with workplace laws and regulations.

What information must be reported on nursing mother accommodation request?

The nursing mother accommodation request should include the employee's name, contact information, breastfeeding schedule, proposed accommodations needed (such as break times and private space), and any supporting documentation.