Free Statewide Mediation Case Information Form - New Jersey

FOR OFFICE USE ONLY

State of New Jersey

DATE RECEIVED:

MEDIATION CASE INFORMATION FORM
Statewide Civil, General Equity and Probate Mediation Program

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 / some issues pending mediation held / no agreement no mediation held / parties settled case before mediation session no mediation held / party failed to attend no mediation held / party attended but failed to participate MANNER OF MEDIATOR SELECTION motion / request of plaintiff motion / request of defendant DATE OF INITIAL MEDIATION SESSION NUMBER OF HOURS OF PREPARATION TIME NUMBER OF HOURS IN SESSIONS consent request by both parties assigned by court DATE OF FINAL MEDIATION SESSION NUMBER OF HOURS PAID BY PARTIES WERE THE PARTIES PREPARED FOR THE MEDIATION SESSIONS? selected by parties

SOURCE OF REFERRAL bench referral DATE CASE ASSIGNED TO MEDIATOR NUMBER OF MEDIATION SESSIONS DID THE ATTORNEYS SUBMIT PROPER CASE SUMMARIES?

yes

no

WERE THE ATTORNEYS PREPARED FOR THE MEDIATION SESSIONS? before any discovery after interrogatories and document production

yes

no

yes

no

AT WHAT STAGE IN THE CASE DID THE MEDIATION SESSION TAKE PLACE? (note all that are applicable)

before depositions after depositions

after experts' reports served after first trial date scheduled

WAS THE TIMING OF REFERRAL TO MEDIATION APPROPRIATE? HAD THIS CASE UNDERGONE ANY PRIOR CDR TECHNIQUE? (e.g. arbitration, early neutral evaluation) IF THE CASE DID NOT SETTLE IN MEDIATION, WHAT WERE THE REASONS? (note all that are applicable)

too early

appropriate time

too late APPROXIMATE DATE

TYPE OF CDR yes no

the proper parties with authority to settle were not present one or both parties did not mediate in good faith

issues were too complex issues were too numerous

one or both parties too entrenched in their positions

RELATIONSHIP OF PARTIES formal business relationship (eg. partnership, corporation) COMMENTS (Please use this section to note any suggestions, concerns or other comments on the pilot program.)

performance of service contract

employee

family

friend

neighbor

no ongoing relationship

PLEASE RETURN TO:

AOC - CIVIL PRACTICE DIVISION BOX 981 TRENTON, NJ 08625 FAX: 609 777-0844

Revised 6/21/2005, CN10526-english

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