MEDIATION REPORT CIVIL ACTION FILE NUMBER: ____________________________ VS. ____________________________ A MEDIATION SESSION WAS HELD ON THE ______DAY OF ______________, 20 AT __________ ON THE ABOVE REFERENCED CASE. THE SESSION LASTED HOURS. PRESENT AT THIS MEDIATION SESSION WERE: NAME AFFILIATION _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ THE RESULTS OF THIS MEDIATION SESSION WERE AS FOLLOWS: ____ _ IMPASSE _____ CONTINUANCE OF MEDIATION TO THE _______DAY OF__________ _ 20 AT ____________. LOCATION:____________________________ _____* PARTIAL SETTLEMENT - TO BE PREPARED BY:____________________ _____* FULL SETTLEMENT - TO BE PREPARED BY:_______________________ * IF APPROPRIATE, A MUTUAL DISMISSAL WITH/WITHOUT PREJUDICE SHOULD BE SUBMITTED TO THE MEDIATION OFFICE. COMMENTS: MEDIATORSIGNATURE_____________________________DATE___________