Contact Name *

We will reach out to this person about the Period Positive Workplace certification

First Name

Last Name

Are period products provided in or near every bathroom used by people who menstruate in your organization? *

This is a requirement to become a certified Period Positive Workplace. This includes bathrooms at every facility, from corporate offices to warehouses and everywhere in between. If you have not yet implemented period products in your workplace, review our Implementation Guide for more information.

Yes

No

Are the period products complimentary for all employees? *

This is a requirement to become a certified Period Positive Workplace.

Yes

No

Are period products for customers and patrons complimentary? *

Yes

No

When did your organization first begin providing period products? *

MM

DD

YYYY

Are the washroom facilities in your workplace equipped with a pit latrine or toilet in a well-lit, well-ventilated, safe area with a locking mechanism; a hand-washing facility that includes clean water and soap or sanitizer; toilet paper; and a waste bin? *

This is a requirement to become a certified Period Positive Workplace.

Yes

No

Have you notified employees that period products are and will continue to be provided? *

This is a requirement to become a certified Period Positive Workplace. You are welcome to inform your employees via any formal notice (e.g., sending an email, announcing it at a staff meeting, updating your employee benefits or HR handbook, etc.).

Yes

No

Will your organization participate in the 30-minute Gender Equity and Menstrual Health educational webinar? *

We will send you upcoming dates of the webinar when we email you.

Yes

No

Do you consent to future contact and data collection pertaining to the implementation of Period Positive Workplaces? *

Yes

No

Do you consent to your organization's logo being displayed on PeriodPositiveWorkplace.org and affiliate material? *

Yes

No

Are you willing to share your story? *

Yes

No

Subscription Consent *

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