Lactation Room After-Hours Access Request
About this free form template

Simplify Lactation Room Access with Professional Scheduling Forms

Supporting nursing parents in the workplace requires thoughtful planning, especially when it comes to after-hours access to private lactation spaces. Our Lactation Room After-Hours Access Request form template helps facilities teams and HR departments streamline the process of granting secure, dignified access to lactation facilities outside regular business hours.

Why After-Hours Lactation Room Access Matters

For parents returning to work after welcoming a new child, maintaining a pumping schedule is essential—and that schedule doesn't always align with standard office hours. Whether employees are working late on projects, coming in early, or working flexible schedules, having reliable access to a clean, private lactation room is both a legal requirement and a compassionate workplace practice.

This form template makes it easy to coordinate access requests, verify eligibility, assign secure privacy codes, and keep facilities management in the loop—all without endless email chains or manual spreadsheets.

What This Template Includes

Our form captures everything facilities and HR teams need to approve and schedule after-hours lactation room access:

  • Employee information and verification to confirm new parent status and estimated duration of need
  • Department and manager details for approval workflows and coordination
  • Flexible scheduling requests including specific days, times, and frequency
  • Privacy and security features with automated code assignment and confidentiality acknowledgment
  • Facilities coordination to ensure rooms are properly maintained, stocked, and accessible
  • Emergency contact information for safety during after-hours access

The form uses conditional logic to show relevant questions based on the employee's schedule and needs, making the experience smooth and respectful.

Perfect for Forward-Thinking Workplaces

This template is ideal for:

  • Corporate offices supporting working parents across different time zones and schedules
  • Healthcare facilities where staff work round-the-clock shifts
  • Manufacturing and production environments with extended operating hours
  • Universities and research institutions accommodating graduate students and researchers
  • 24/7 operations in hospitality, security, and emergency services

Any organization committed to supporting nursing parents will benefit from a structured, dignified process for granting after-hours access to lactation facilities.

Designed to Be Compliant and Compassionate

Under the PUMP Act and various state laws, employers must provide reasonable break time and a private space (other than a bathroom) for nursing employees. This form helps you meet those obligations while respecting employee privacy and maintaining building security.

The template balances legal compliance with human-centered design—treating access requests with the sensitivity they deserve while still capturing the operational details facilities teams need.

Automate Workflows with Stepper

Once a request is submitted, you can use Stepper (stepper.io) to automate the approval and coordination process:

  • Route requests to managers and facilities teams for review
  • Send automated emails with assigned privacy codes and access instructions
  • Update calendars or access control systems with scheduled times
  • Trigger reminders for facilities to restock supplies and perform maintenance
  • Log requests in HR systems for compliance tracking

This means less manual coordination, faster turnaround times, and a better experience for employees during an already demanding time.

Customizable for Your Workplace

While the template provides a comprehensive starting point, you can easily customize it to match your organization's specific needs:

  • Add or remove scheduling options based on your building's hours
  • Include fields for specific room preferences if you have multiple locations
  • Integrate with your badge or keycard access systems
  • Add questions about equipment needs (fridge access, pump storage, etc.)
  • Tailor the language to match your company's tone and culture

Why Paperform for Facilities Management

Paperform is trusted by HR and facilities teams worldwide because it combines professional design with powerful functionality. Our forms look polished and on-brand, work seamlessly on mobile devices, and include the conditional logic and automation features you need to streamline operations.

With SOC 2 Type II compliance, role-based permissions, and secure data handling, Paperform gives you the confidence that sensitive employee information is protected. And because it integrates with the tools you already use—like Slack, Google Workspace, Microsoft Teams, and hundreds of others via Stepper—you can fit this form right into your existing workflows.

Get Started in Minutes

Supporting nursing parents shouldn't require complicated systems or custom development. With this template, you can launch a professional after-hours lactation room access request process in minutes, giving your team a simple, respectful way to request access and giving facilities teams the information they need to coordinate effectively.

Create a workplace culture that supports all parents with tools that make compliance and compassion equally easy.

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michelin-4.png
raywhite.png
suncorp-logo-358x104.png
unesco.png
Bitmap.png
HIR.png
HKTB-logo.png
Kenyon.png
Rice_University_Horizontal_Blue.png
accor-3.png
adp-1.png
avallain-logo-svg-160-px.png
axa-768.png
danone-2.png
deloitte-1.png
logo_andorra_telecom_df137f1a8f.png
michelin-4.png
raywhite.png
suncorp-logo-358x104.png
unesco.png
Bitmap.png
HIR.png
HKTB-logo.png
Kenyon.png
Rice_University_Horizontal_Blue.png
accor-3.png
adp-1.png
avallain-logo-svg-160-px.png
axa-768.png
danone-2.png
deloitte-1.png
logo_andorra_telecom_df137f1a8f.png
michelin-4.png
raywhite.png
suncorp-logo-358x104.png
unesco.png
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