
	International Code Monitoring Form What is the International Code? Understanding the International Code Code Resolutions Provisions Innocenti Declaration CODE Monitoring Form Let INFACT Canada know who’s playing by the rules and who's not. Give us as much detailed information as you can - dates, places, company or brand names. If possible, send photos or actual examples of anything you think may be a Code violation (labels, pamphlets, ads, posters, note pads). ARE MAGAZINES STILL ADVERTISING BREASTMILK SUBSTITUTES, BOTTLES OR NIPPLES? YesNo Example: ARE MOTHERS RECEIVING PROMOTIONAL PAMPHLETS OR BOOKLETS FROM HOSPITALS, STORES OR BY DIRECT MAIL? YesNo Brand: Received from: DO PRODUCT LABELS SHOW PICTURES OF BABIES? YesNo Brand/Company: Where seen: DOES LABEL HAVE HAZARD WARNINGS AND CLEAR INSTRUCTIONS? YesNo ARE MOTHERS STILL GETTING FREE FORMULA SAMPLES? YesNo Brand/Company: Where given: How given: DO HOSPITAL PRACTICES DISCOURAGE BREASTFEEDING? Strict schedules Unnecessary separation of mother and baby Routine use of water or formula supplements Staff use of brand-name gifts such as pads, calendars, pens, posters Anything else? Name/address of hospital/clinic: IS BREASTFEEDING ACTIVELY SUPPORTED IN YOUR REGION? Posters Booklets Films Public and workplace facilities for breastfeeding mothers Anything else? *We need your Name* and Email address: Keep confidential?YesNo Your Name: Your Email: Voice Numbers**: Other comments: Top

International Code Monitoring Form

CODE Monitoring Form

Let INFACT Canada know who’s playing by the rules and who's not.

Give us as much detailed information as you can - dates, places, company or brand names. If possible, send photos or actual examples of anything you think may be a Code violation (labels, pamphlets, ads, posters, note pads).

ARE MAGAZINES STILL ADVERTISING BREASTMILK SUBSTITUTES, BOTTLES OR NIPPLES?

YesNo

Example:

ARE MOTHERS RECEIVING PROMOTIONAL PAMPHLETS OR BOOKLETS FROM HOSPITALS, STORES OR BY DIRECT MAIL?

YesNo

Brand:

Received from:

DO PRODUCT LABELS SHOW PICTURES OF BABIES?

YesNo

Brand/Company:

Where seen:

DOES LABEL HAVE HAZARD WARNINGS AND CLEAR INSTRUCTIONS?

YesNo

ARE MOTHERS STILL GETTING FREE FORMULA SAMPLES?

YesNo

Brand/Company:

Where given:

How given:

DO HOSPITAL PRACTICES DISCOURAGE BREASTFEEDING?

Strict schedules

Unnecessary separation of mother and baby

Routine use of water or formula supplements

Staff use of brand-name gifts such as pads, calendars, pens, posters

Anything else?

Name/address of hospital/clinic:

IS BREASTFEEDING ACTIVELY SUPPORTED IN YOUR REGION?

Posters

Booklets

Films

Public and workplace facilities for breastfeeding mothers

Anything else?

We need your Name and Email address: Keep confidential?YesNo

Your Name:

Your Email:

Voice Numbers:

Other comments:

Top