Free Lemon Law Mediation - MEDIATOR CASE INFORMATION FORM - New Jersey

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State of New Jersey MEDIATOR CASE INFORMATION FORM Lemon Law Mediation

For office use only
Date Received: Date Entered-AOC:

DIRECTIONS: This form is to be completed by the mediator when the mediation is concluded or returned to court. Case Docket Number County Last Name Of Mediator First Name Of Mediator

Outcome / Nature of Agreement: mediation held / full agreement on all issues mediation held / no agreement mediation held / some issues pending no mediation held / party failed to attend no mediation held / parties settled case before mediation session no mediation held / party attended but failed to participate Source of Referral: bench referral motion / request of defendant Manner of mediator selection assigned by court
Date case assigned to mediator

motion / request of plaintiff consent request by both parties selected by parties
Date of initial mediation session Date of final mediation session

No. of mediation sessions

No. hrs. of prep time

No. hrs. in session

No. hrs. paid by party

Did the attorneys submit proper case summaries?
Were the attorneys prepared for the mediation sessions ?

Were the parties prepared for the mediation sessions? Was the timing of referral to mediation appropriate? too early appropriate time too late

Yes Yes Yes

No No No

Had this case undergone any prior cdr technique? (e.g., arbitration, early neutral evaluation) Yes No If the case did not settle in mediation, what were the reasons? (note all that are applicable) the proper parties with authority to settle were not present issues were too complex issues were too numerous one or both parties too entrenched in their positions one or both parties did not mediate in good faith Comments (Please use this section to note any suggestions, concerns or other comments on the program)

PLEASE RETURN TO: Civil Practice Division Box 981 Trenton, NJ 08625 FAX: (609) 777-0844

Revised 8/2006, CN 10828-English

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