MAIL TO: ADR Program Coordinator, 3055 Cleveland Ave., Santa Rosa, CA 95403 OR FAX TO: (707) 521-6756 SONOMA COUNTY SUPERIOR COURT CIVIL ADR PROGRAM MEDIATOR'S QUESTIONNAIRE (CONFIDENTIAL) In accordance with Local Rule 16.4 B please submit completed questionnaire by FAX or mail within 5 (five) days of completion of mediation. This confidential information will be used to 1) evaluate the court's mediation program and 2) to report to the court and to the Administrative Office of the Courts regarding the impact of the court's mediation program for general civil cases. Information from this form will not be shared with the trial judge, other court staff, or other participants in the mediation and will be presented only in aggregate form, without attribution to you, any of the participants, or this case. Case Name: Name of Neutral: PART I - GENERAL INFORMATION Case Number: 1. Are you a member of the Sonoma County Superior Court Panel of Mediators? G Yes G No If yes, skip to Part II 2. Total Hours of Mediation Training: G under 20 G 21-40 G 41 to 80 G more than 80 3. Total # cases in which you served as a mediator: G under 20 G 21 to 50 G 51 ­ 100 G 100+ 4. Professional background (check all that apply): G Full time dispute resolution professional G Retired Judge or Bench Officer G Attorney G Other (please specify): PART II - MEDIATED MATTER Please do not disclose confidential information 1. Did you conduct a pre-mediation conference? 2. Was the matter settled? G Yes G No G during the mediation G not settled G Yes G No G Yes G No G before the mediation G after the mediation 3. From your perspective: Was the case suitable for mediation? Was the case ready for mediation? If your answer to either question was no, please check all applicable factors: G Mediation was scheduled too early G a necessary person was not present or G attended by telephone One or more participants, including counsel (check all that apply): G were not prepared G did not appear to understand the mediation process G did not appear to be willing to negotiate G were unwilling to participate for a sufficient time G There were language barriers or other communication problems G The parties could not afford sufficient hours of mediation time G Other (Please specify): 4. What style of mediation did you use in this case? G Facilitative G Directive G Other 5. Did you discuss the law? G Yes G No Did the disputants ask about the law? G Yes G No Total # of sessions: Total number of follow-up 6. Approximate # total hours of mediation: communications (calls / letters / email / other): _____ 7. Do you have any comments or suggestions regarding the Court's ADR Program? CV-36 [Rev. 7/1/11] Form Adopted for Mandatory Use MEDIATOR QUESTIONNAIRE (CONFIDENTIAL) Page 1 of 1 American LegalNet, Inc. www.FormsWorkFlow.com