WW2224

Online questionnaire

1. Correct and complete the address of this breastfeeding place.

name
address
postcode, city
telephone
E-mail
I would like to be regularly informed about the activities of mamamap at the e-mail address mentioned above.

www

2. Check all that apply.

I am responsible for this breastfeeding place.
I am user.
Other

3. Complete the contact information concerning this breastfeeding place.

(These data will not be published.)
contact person
telephone
E-mail
I would like to be regularly informed about the activities of mamamap at the e-mail address mentioned above.

4. Please move the marker to the correct position.



5. What are the opening hours of the breastfeeding place?

Mo

Tu

We

Th

Fr

Sa

Su

6. How do you get to this breastfeeding place once inside the buiding?

free access
ask he staff for access

7. On which floor is this room located? Is there a room number or special label?

8. Is there an elevator?

yes     no     unknown

9. Additional info about the breastfeeding place:

concealed from view yes     no     unknown
lockable yes     no     unknown
nursing pillow yes     no     unknown
sink yes     no     unknown
possibility for changing diaper yes     no     unknown
power outlet yes     no     unknown
bottle warmer yes     no     unknown
sibling friendly yes     no     unknown
toilette available yes     no     unknown
pressure to consume yes     no     unknown
other:

10. To which categories belongs this breastfeeding place?

Hospital/home
Pharmacie/chemist's shop
Library
Coffee house/restaurant
Museum
Shop
Shopping centre
Childwelfare clinic
Parent Counselling Service
other:

11. How is the breastfeeding place marked?




other
none

12. Is there enough room for a stroller?

yes     no     unknown

13. Is the breastfeeding place separated?

unknown
no separate room
separate room
nursing corner with some privacy

14. Additional text for this breastfeading place:

15. Do you have any remarks?

(will not be published)