have received and reviewed the guidelines for the use of the Department of Law Lactation Room and have had an opportunity to ask questions and have had them answered to my satisfaction.

I will begin using the Lactation Room for an approximate period of months (required) for the designated purpose of expressing my breast milk, beginning on or about the date of (required)

I understand that Lactation Room access is granted solely for lactation purposes and that I am responsible for the following:

  1. bringing my own breast pump and supplies;
  2. sanitizing the countertop, sink and other surface areas before and after expressing milk;
  3. cleaning up any spills or other untidiness created during use of the room;
  4. contacting designated personnel in the event of a spill;
  5. securing the room after each use when applicable;
  6. respecting the privacy of other lactation room users; and
  7. notifying the Georgia Department of Law when access to the Lactation Room is no longer needed.

I understand that I will have access to and may utilize the refrigerator in the Lactation Room for the storage of expressed breast milk. If I elect to use the refrigerator to store expressed breast milk, I understand the following:

  1. I am required to label my milk with my name, department, telephone number and the date the milk was expressed.
  2. I am required to remove all my stored breast milk by end of business each day.
  3. Stored milk that has not been removed by the end of the business day may be disposed of.
  4. I am responsible for ensuring that the refrigerator is always kept clean.
  5. Georgia Department of Law and the Georgia Building Authority (GBA) are not responsible for the contents of refrigerator or any loss of or damage to my stored breast milk.

I understand that:

  1. I should not leave any personal items or equipment in the lactation room.
  2. I should not store food or drink in the refrigerator.
  3. Ice packs, containers or other accessories are not provided; therefore, it is my responsibility to furnish these items.