Questionnaire For Attorneys In Mediated Cases Form. This is a New York form and can be use in District Court Federal.
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Mediation Program Eastern District of New York Questionnaire for Attorneys in Mediated Cases Our records indicate that you recently represented a client in a case referred to mediation authorized by EDNY Local Rule 83.11. To evaluate the performance of our Mediators, we need to know the views of those who have participated in the mediation session. This questionnaire asks about your experience in the case identified below. Your responses are confidential and will not be known to the court, other attorneys, the mediator, or the parties. Please answer all questions with reference to the following case only: ________________________ v. _____________________________ Docket Number: __________________________________________ Type of case _____________________________________________ Mediator ________________________________________________ Mediation Session date (s) __________________________________ If you were not present at the mediation session in this case, please provide any information to help us contact the correct attorney and return the blank questionnaire in the enclosed envelop. Attorney name: Firm name: Address: ________________________________________ _________________________________________ _________________________________________ __________________________________________ Telephone: Fax: __________________________________________ __________________________________________ ________________________________________ American LegalNet, Inc. www.FormsWorkFlow.com Mediator Evaluation Questionnaire for Attorneys in Mediated Cases December 2000 Mediator Evaluation Page 2 1. Overall, how helpful or detrimental was the mediation in the resolution of this case? Please check one response. (__) 1. Very helpful. (__) 2. Somewhat helpful. (__) 3. It had little impact on the case. (__) 4. Somewhat detrimental. (__) 5. Very detrimental. 2. Was your client present at the mediation session (s)? (__) 1. Yes. (__) 2. No. 3. Was a Mediation Statement submitted on behalf or your client prior to the first session? (__) 1. Yes (__) 2. No 4. Was a settlement worked out at the mediation session (s)? (__) 1. Yes (__) 2. No American LegalNet, Inc. www.FormsWorkFlow.com 5. Approximately how many hours did the mediation session (s) last? ____ hours Mediator Evaluation Page 3 6. How do you rate the Mediator on each of the following points: Poor Fair Good Very Excellent Good 1 2 3 4 5 Knowledge of the law Preparation Fairness and Impartiality Creative Problem Solver __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ Comments ______________________________________________ _______________________________________________________ 7. Was the Mediator effective in getting the parties to engage in meaningful discussion of this case? _____ yes _____ no Explain ___________________________________________________ __________________________________________________________ 8. Check which of the following skills the Mediator possessed: American LegalNet, Inc. www.FormsWorkFlow.com (a) (b) (c) ability to listen actively. (__) ability to analyze problems, identify and separate the issues involved and frame these issues for solution or decision making. (__) ability to use clear neutral language in speaking. (__) Mediator Evaluation Page 4 (d) (e) (f) sensitivity to strongly felt values of the participants, including gender, ethnic, and cultural differences. (__) ability to deal with complex factual materials. (__) presence and persistence. Ability to create and maintain control of a diverse group of disputants. (__) ability to earn trust and maintain acceptability. (__) ability to screen out non-mediatable issues. (__) (g) (h) (i) (j) (k) ability to help parties to invent creative options. (__) ability to help parties assess their non-settlement alternatives. (__) ability to help the parties assess their own informed choices. (__) 9. Would you recommend this Mediator? Not at all Reluctantly Somewhat Highly 1 2 3 4 __ __ __ __ Any comments or suggestions you may have about the Mediator or the mediation program or its application to this case are welcome. Please use the back of this page. THANK YOU. Robyn Weinstein, ADR Administrator Please return this questionnaire to: United States District Court, Eastern District of New York 225 Cadman Plaza East Brooklyn, NY 11201 firstname.lastname@example.org Phone: (718) 613-2875 American LegalNet, Inc. www.FormsWorkFlow.com