Lactation Room Evaluation

1. How old was your child when you returned to work? Weeks

2. Did you return to work sooner because the Lactation Room was available? Yes No

3. Did the availability of the Lactation Room influence your decision to breastfeed? Yes No
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4. How long did you plan to breastfeed when you first returned to work? Months Weeks

5. How long did you breastfeed? Months Weeks

6. Was the Lactation Room available when you needed it? Yes No

7. Did you have any problems using the Lactation Room? Yes No
If you had problems, please explain:

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8. Do you have any suggestions to improve the Lactation Room?
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9. Other Comments
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10. Verification    (Not readable? Generate new image.)

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