Workplace Lactation Room Request & Accommodation Form
Workplace Lactation Room Request & Accommodation Form
HR request form for nursing parents to reserve a private lactation room, arrange schedule, and confirm storage needs under PUMP Act.
Under federal law, employers must provide reasonable time and a private space for nursing employees to express milk.
Employee full name *
Your answer
Employee ID *
Your answer
Department / manager *
Your answer
Work email
Phone
Work location / building
Your answer
Date returning from leave
+ 10 more questions
About this template
HR request form for nursing parents to reserve a private lactation room, arrange schedule, and confirm storage needs under PUMP Act.
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