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Monitoring form: Materials for health workers

Your name and contact details will not appear in BFLG's published reports.

If appropriate this form will be forwarded to the Trading Standards home authority for the manufacturer concerned.

If you are a health worker, we would like to conduct a fuller telephone interview with you. Please contact the BFLG Monitoring Coordinator, Mike Brady, c/o Baby Milk Action on mikebrady@babymilkaction.org.

If you have information on company materials, please complete this form in addition to giving the telephone interview. We will require an example of the materials or a good photocopy. Please send my email to Mike Brady or to the address given below.

Required details

Enter your name here:

Monitors identity number (if one has been assigned to you):

Please continue to the 'details of promotion' section if you have a monitors identity number or have given the following information before on a monitoring form.

Enter your email address here:

Re-type your email address here:

Your telephone number:

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Optional details

Position:

Organisation:

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Details of promotion

Title or heading on the materials :

Date (please select one) of publication of observation of delivery by company is / / (dd/mm/yyyy)

To what product does the material refer?

Manufacturers name:

Product brand name:

Type of product (please select one): Infant formula Follow-up formula Special formula Cereal Fruit/vegetable/meat puree Sweetened condensed milk Bottle Teat Other (please indicate)

Type of material (please select one): Booklet Leaflet Advertisement Video cassette Audio cassette Compact disk Display Web page Poster Software Other (please specify below)

Where was the material found/observed (select one): General hospital Maternity Paediatric hospital Clinic Doctor's office Health centre Pharmacy Junk mail Scientific journal Internet Other (please indicate below)

Name of place/media where it was found/observed:

Is the place/media: Public Private

Is the material made available to mothers? Yes No

If the material is made available to mothers, how does it reach mothers (select one): Company rep. Health worker Other

Further information:

It will be helpful if you can complete the following analysis of the material. If you do not have time to do so, please go to the bottom of the form to submit it.

Promotional message Does the material contain promotional messages (i.e. information which is NOT scientific and factual)? Yes No If yes, describe how the information is promotional and not scientific and factual:

Missing information The Code requires certain information. Check each one and indicate if it is missing or present. a statement on the benefits and superiority of breastfeeding Missing Present a statement on the negative effect on breastfeeding of introducing partial bottle feeding Missing Present a statement on the difficulty of reversing the decision not to breastfeed Missing Present a statement on maternal nutrition, and the preparation for and maintenance of breastfeeding Missing Present

Material about infant formula Does the material provide information about infant formula? Yes No If yes, answer this section. The Code requires certain information for infant formula. Check each one and indicate if it is missing or present. a statement on the proper use of infant formula Missing Present a statement on the social and financial implications of the use of infant formula Missing Present a statement on the health hazards of inappropriate foods or feeding methods Missing Present a statement on the health hazards of unnecessary or improper use of formula or other breastmilk substitutes Missing Present

All material Does the material imply that bottle feeding is equivalent or superior to breastfeeding? Yes No If yes, please describe: Does the material use pictures or text idealising the use of breastmilk substitutes? Yes No If yes, please describe: Any additional comments?

Before submitting the form, you may wish to print this page for your own records.

If you have photographs or materials to support your report, please send this by email to mikebrady@babymilkaction.org or to the address below. Include a note giving your name and the date you submitted this form. If you are sending a lot of materials, please attach a copy of this form to the relevant pieces or otherwise clearly identify them. Materials should be sent to:

BFLG Monitoring,
c/o Baby Milk Action,
34 Trumpington Street,
Cambridge,
CB2 1QY.

Many thanks for your information.

Please check this box if you have reported the above violations to your local Trading Standards office - click here to send a report via the Trading Standards website, or find the number in your telephone book.