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MODEL LACTATION ROOM REQUEST FORM EMPLOYEE INFORMATION Print Full Name: ? Current Employee ? Other Address: Phone Number: Title: Email: Office Telephone Number:Division: Supervisor Name and Phone
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How to fill out model lactation room request

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How to fill out model lactation room request?

01
Write your name, contact information, and job title at the top of the form.
02
Provide the name of your employer or organization.
03
Specify the location where the lactation room is requested, including the building name and address.
04
Indicate the reason for needing a lactation room, whether it is for personal breastfeeding or expressing milk for a baby.
05
State the frequency and duration of your need for a lactation room, such as during regular working hours or specific breaks.
06
If applicable, mention any specific amenities or requirements you may need in the lactation room, such as a comfortable chair, electrical outlets, or a refrigerator for storing expressed milk.
07
Include any supporting documentation or medical certificates, if required by your employer or organization.
08
Sign and date the request form.

Who needs model lactation room request?

01
Employees or individuals who are nursing or expressing milk for their baby.
02
Individuals working in organizations or workplaces that promote a supportive and inclusive environment for breastfeeding mothers.
03
Those who require a private and comfortable space to breastfeed or pump milk during working hours.

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The MODEL LACTATION ROOM REQUEST - jacksonlewis.com is a fillable form in MS Word extension that should be submitted to the required address in order to provide certain info. It must be completed and signed, which can be done in hard copy, or using a particular software e. g. PDFfiller. It helps to complete any PDF or Word document directly from your browser (no software requred), customize it according to your purposes and put a legally-binding electronic signature. Once after completion, you can easily send the MODEL LACTATION ROOM REQUEST - jacksonlewis.com to the relevant individual, or multiple individuals via email or fax. The editable template is printable as well from PDFfiller feature and options proposed for printing out adjustment. In both digital and in hard copy, your form will have got neat and professional appearance. Also you can save it as the template to use later, so you don't need to create a new document from the beginning. All that needed is to amend the ready form.

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A model lactation room request is a standardized form designed to facilitate the establishment or maintenance of designated spaces for nursing mothers to express milk comfortably and privately.
Typically, employers or organizations that need to provide lactation accommodations for their employees are required to file a model lactation room request.
To fill out a model lactation room request, you should provide relevant details such as the location of the proposed lactation room, the intended use, dimensions, and any additional amenities needed to support nursing mothers.
The purpose of the model lactation room request is to ensure that nursing mothers have access to a private and comfortable space for breastfeeding or expressing milk, thereby supporting their health and rights.
The information that must be reported on a model lactation room request includes the applicant's details, the location of the lactation room, specific requirements for the room (like privacy and sanitation), and a proposed schedule for its use.
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