California Hospital Infant Feeding Survey

California WIC Association is conducting a survey of California hospitals during spring of 2014 to identify hospitals that have, and post, their Infant Feeding Policy, as required by Senate Bill 502 (Pavley-De Leon, 2011).

Your help is requested to gather this information for your community. Please work with your local hospital, or your colleagues in your hospital, to complete and return this survey regarding implementation of SB 502. Thank you!

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* 1. Today's Date:
(or date hospital survey was taken)

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* 2. Name of hospital:

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* 3. Location/City:

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* 4. Hospital contact for inquiries regarding breastfeeding policy:

Contact name:

Contact position:

Contact phone number:

Contact email address:

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* 5. Is a hospital infant feeding policy posted online internally for employees to access?

YES

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* 6. Is a hospital infant feeding policy posted online externally for patients and public to access?

YES

If yes, please provide link:

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* 7. Is a paper copy of the hospital infant feeding policy available, such as in a binder?
Check all that apply:

There is not a paper copy of the policy available

There is a paper copy of the policy available in labor & delivery

There is a paper copy of the policy available in the postpartum unit

There is a paper copy of the policy available in the birthing center

There is a paper copy of the policy available in the pediatrics unit

There is a paper copy of the policy available in the normal newborn care unit

There is a paper copy of the policy available in the newborn special care unit

There is a paper copy of the policy available elsewhere

If available elswhere, please describe:

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* 8. Is the hospital’s policy based on the Baby-Friendly Ten Steps, the California Model Hospital Policies, or another source?
Please check the appropriate answer, or list the source:

Baby Friendly Hospital Initiative Ten Steps

California Model Hospital Policies

Other

If other, please describe:

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* 9. If there is NO infant feeding policy:

A policy is not yet developed

The policy is in use, but not yet posted

The policy is currently being developed

The policy has been developed and is currently under review

Other (please specify)

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* 10. Please provide your contact information - if different from hospital contact person:

Name:

Company/Organization:

Phone number:

Email address:

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* 1. Today's Date:(or date hospital survey was taken)

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* 2. Name of hospital:

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* 3. Location/City:

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* 4. Hospital contact for inquiries regarding breastfeeding policy:

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* 5. Is a hospital infant feeding policy posted online internally for employees to access?

Question Title

* 6. Is a hospital infant feeding policy posted online externally for patients and public to access?

Question Title

* 7. Is a paper copy of the hospital infant feeding policy available, such as in a binder?Check all that apply:

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* 8. Is the hospital’s policy based on the Baby-Friendly Ten Steps, the California Model Hospital Policies, or another source? Please check the appropriate answer, or list the source:

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* 9. If there is NO infant feeding policy:

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* 10. Please provide your contact information - if different from hospital contact person:

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* 11. Any additional comments?

* 1. Today's Date:
(or date hospital survey was taken)

* 7. Is a paper copy of the hospital infant feeding policy available, such as in a binder?
Check all that apply:

* 8. Is the hospital’s policy based on the Baby-Friendly Ten Steps, the California Model Hospital Policies, or another source?
Please check the appropriate answer, or list the source: