Business Outreach Visit

Please complete this form on the same day as your business outreach visit is performed.

Anticipated follow-up information:
*Your Name:
*Your Email Address:
*Name(s) of other trainees in group:
*Name of Business:
*Date to contact (mm/dd/yyyy): / /
*Contact person / title
*Contact method

Which portion(s) of the Business Case for Breastfeed Resource Kit and what other materials did you provide to the business (Check all that apply):

Employer Toolkit Handouts & CD (in folder + your business card)
Employer Toolkit Table of Contents
Breastfeeding Resource Directory
The Business Case (Folder 1)
Easy Steps Booklet (Folder 2)
Employees Guide (Folder 4)
Entire Resource Kit
Other Materials

Did you refer the business to local IBCLCs or other lactation professionals?
Yes No
Did you inform the business about the mini-grant application?
Yes No
Did you inform the business about the upcoming Workplace Recognition Awards?
Yes No
Did the business indicate that they intended to implement a lactation support program?
Yes No


P.O. Box 29214, Washington, DC 20017 • Tel 202-470-2732 • email info@dcbfc.org

Medical Disclaimer: The information presented here is not intended to diagnose health problems, breastfeeding problems, or to take the place of professional medical care. If you have persistent breastfeeding problems, or if you have further questions, please consult your health care provider. The DC Breastfeeding Coalition does not share partnership with, or have any vested interest in, any of the businesses that may appear on this site, or sites that may be accessible by links herein contained.