Free Mediation Report - New Hampshire

THE STATE OF NEW HAMPSHIRE
JUDICIAL BRANCH
http://www.courts.state.nh.us

Court Name: Case Name: Case Number:
(if known)

MEDIATION QUESTIONNAIRE
MEDIATOR DATE OF MEDIATION I am: Plaintiff Attorney for Plaintiff Other Interested Party
Select one response for each statement made below. 1. The mediator explained the mediation process clearly so that I knew what to expect during the mediation session. 2. The mediator was impartial and treated all parties equally. 3. The mediator gave me an opportunity to fully explain the dispute. 4. The mediator listened to and understood my perspective 5. The mediator was able to facilitate discussion successfully. 6. The mediator helped us explore different options to resolve the dispute. 7 Overall, I was satisfied with the way the mediator handled the case and the mediation process. 8. I would consider mediation for other matters even if I had to pay the costs. 9. I would use this mediator again or recommend him or her to others.

Defendant Attorney for Defendant Attorney for Interested Party Strongly Agree Agree Not Sure Disagree Strongly Disagree

10.

Mediation had the following impact on this case: (Fill all that apply.) settled the case little or no impact allowed the parties to better understand each other

11.

If the mediation was not successful, which of the following reasons best explains why? one or both of the parties felt they were too far apart in their positions or too entrenched in their positions to resolve the matter one or both of the parties failed to participate in good faith one or both of the parties wanted the Court to resolve the matter mediator not helpful other

NHJB-2491-S (01/02/2008)

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Case Name: Case Number: Mediation Questionnaire

12.

What did the mediator do well during your mediation session?

What could the mediator have done better during the mediation session?

13.

What do you like about the mediation program?

How would you change the mediation program?

14.

Please provide any other comments you think would be helpful in evaluating the effectiveness and quality of the mediator or the mediation process.

Please place questionnaire in sealed envelope and give to mediator to be returned to court staff.

NHJB-2491-S (01/02/2008)

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