Lactation Accommodation Contract

Lactation Accommodation Contract

_______________________ (hereafter “Employee”) and _______________________ (hereafter “Employer”), hereby agree to the following lactation accommodations for the Employee:

The Employee has submitted a written request for lactation accommodation and has had it approved by HR. The current agreement begins {date} and will continue until {date} or until the Employee no longer requires the accommodations.

The Employee may express milk during one of their paid breaks or may take additional unpaid breaks to express milk. The Employee must clock out beforehand. The Employer may postpone the Employee’s break if the break would seriously interrupt company operations but may not deny the opportunity to express milk longer than {amount of time}.

The Employee may use the {room} room for privacy while expressing milk. If the room is in use when the Employee requires its use, they may alternately use the {room} room.

The Employee must provide their own {pumping equipment, bottles, sanitation equipment, refrigeration unit, travel accoutrements}. The Employer will provide {pumping equipment, bottles sanitation equipment, refrigeration unit, travel accoutrements}.

The Employee must clean up any messes made while expressing milk. Any spills must be reported to {Name} at {contact information}.

Expressed milk may be stored in the refrigerator until {time/day}. If it is not removed after that time, the Employer may dispose of it.

In witness to their agreement to the terms of this contract, the parties affix their signatures below:

____________________________________

Employee, signature & date

____________________________________

Employer, signature & date

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