MEDIATOR EVALUATION FORM U.S. DISTRICT COURT DISTRICT OF COLUMBIA CIRCUIT Case Name: Mediator: Case Number: Study Number: 1. Was an agreement reached? Yes No 2. How many sessions were held? _____ hours 3. How much time was spent mediating this case? - How much time was spent mediating with attorneys and/or parties in person? - How much time was spent mediating by phone? hours _____ hours 4. How much time did you have to complete mediation from the assignment of the case until mediator completion deadline? 5. Was this time adequate? Yes ______weeks No____ Please explain: ____________________________________________________________________ _________________________________________________________________________________ 6. Who attended the mediation session(s)? Sessions for Plaintiff: 1st Party and Counsel Counsel Only 3rd ____ ____ ____ ____ ____ ____ ____ Sessions for Defendant: ____ ____ ____ Party Only Other 2nd 2nd 3rd Party and Counsel ____ 1st ____ ____ ____ ____ ____ ____ ____ ____ ____ Counsel Only ____ ____ Party Only Other ____ ____ American LegalNet, Inc. www.FormsWorkflow.com 7. If parties were not present at the mediation, do you think their presence would have aided the process? Yes No Please explain: _______________________________________ __________________________________________________________________________________ __________________________________________________________________________________ 8. Please list the main issues in this case: ___________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ 9. What motions, if any, were pending at the time this case entered mediation? ____________________ __________________________________________________________________________________ 10. Were there any intervener? Yes No 11. How much time did you spend preparing for the mediation? 12. Date of first mediation session: ________________________________________________________ 13. Date of final mediation session: _______________________________________________________ 14. Do you think mediation was an appropriate technique for this case? hours Yes No If not, why? _______________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ 15. The Circuit Executive's Office is trying to classify mediated cases by type. Please check the category that best describes this case. Contract Constitutional torts (prisoner petitions) Constitutional torts (Other) Employment (incl. civil rights) Civil Rights (other than employment) Fraud Malpractice Patent/Trademark/Copyright Personal Injury (Auto) Personal Injury (Other Property Damage Regulatory/Public Policy If you cannot decide how to categorize the case or if it does not fall into any of the categories listed, please write a one or two sentence description. _______________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ 16. Any other comments about the case or program may be written below: At the completion of the mediation process, please return this evaluation in the returned envelope to: The Mediation Program, Room 4826, E. Barrett Pretty man U.S. Courthouse 333 Constitution Avenue, NW, Washington, D.C. 20001 American LegalNet, Inc. www.FormsWorkflow.com American LegalNet, Inc. www.FormsWorkflow.com