Evaluation Of Mediation Sessions And Mediators Form. This is a Virginia form and can be use in Supreme Court Statewide.
Tags: Evaluation Of Mediation Sessions And Mediators, ADR-1002, Virginia Statewide, Supreme Court
SUPREME COURT OF VIRGINIA Office of the Executive Secretary Evaluation of Mediation Session(s) and Mediator(s) This information will be used to inform the court system and the mediator(s) about your experience with mediation. With your help, we can ensure that quality mediation services continue to be available to the citizens of the Commonwealth. This information may be shared with the mediator(s). I. Session Evaluation Name: ____________________________________________ Date: _____________ Address: ________________________________________________________________ Street _________________________________________________________________________ City State Zip Phone Number: (Day) _____________________ (Evening) ______________________ 1. I am (check one): □ a party to the dispute □ an attorney representing a party 2. For this case, mediation was (check one): □ very appropriate □ somewhat appropriate □ not at all appropriate Comments: _____________________________________________________________________ ______________________________________________________________________ 3. Total hours spent in the mediation session(s): ________ Number of Sessions: ______ 4. The mediation process was: □ very helpful □ somewhat helpful □ not at all helpful 5. Mediation ended with an agreement on: □ all of the issues □ some of the issues □ none of the issues 6. Would you use mediation again? □ yes □ no 7. Would you recommend mediation to others? □ yes □ no FORM ADR-1002 revised July 2008 (OVER) American LegalNet, Inc. www.FormsWorkflow.com II. Mediator Evaluation Mediator A: _____________________ Mediator B: __________________________ Print First & Last Name Print First & Last Name _____________________ ______________________ Mediator's Certification Number Mediator's Certification Number Please rate your mediator(s) on the following. Circle the appropriate number. 5 = Very Good 4 = Good 3 = Adequate 2 = Unsatisfactory 1 = Poor 0 = Does not apply The Mediator . . . Mediator A 1. explained the mediation process and procedures. 543210 543210 2. provided useful information. 543210 543210 3. was a good listener. 543210 543210 4. allowed me to talk about issues that were important to me. 543210 543210 5. was respectful. 543210 543210 6. helped clarify issues. 543210 543210 7. encouraged us to come up with our own solutions. 543210 543210 8. informed me that I could consult an attorney. □ yes □ no 9. was neutral. □ yes □ no □ yes □ no □ doesn’t apply 10. wrote our agreement clearly and accurately Mediator B 11. Share any comments on the mediation process and/or the mediator(s): __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ Please return this Form to the Mediator or Program Director, or mail directly to: Dispute Resolution Services Office of the Executive Secretary Supreme Court of Virginia FOR MEDIATOR USE ONLY 100 North Ninth Street Court: JDR GD/SC Circuit Richmond, VA 23219 Type of Dispute: ________________________ Source of Referral: Court Coordinator Private FORM ADR-1002 revised July 2008 American LegalNet, Inc. www.FormsWorkflow.com