This is a sample Mediation Evaluation Form from U.S. Department of the Interior, Bureau of Reclamation

Evaluation of Structured Mediation
as an alternative dispute resolution process

1. Was this the first time you were in mediation to resolve a dispute, complaint, grievance, or conflict?

Yes

No

If yes, move on to question 3

2. How did the mediation process utilized this time compare to the dispute resolution process or forum with which you've previously been involved?

	agree			disagree
a. The mediation process was faster.	1	2	3	4	5
b. I was more satisfied with the results.	1	2	3	4	5
c. I communicated better with the other party(ies).	1	2	3	4	5
d. I would recommend mediation to others.	1	2	3	4	5

3. With respect to the mediation recently completed:

	agree			disagree
a. Most of my issues/concerns were resolved.	1	2	3	4	5
b. I understand the real issues better.	1	2	3	4	5
c. The other party (ies) understands my perspective better as a result of the mediation.	1	2	3	4	5
d. I understand the other party (ies) perspective better as a result of the mediation.	1	2	3	4	5
e. I feel the work environment (if applicable) has improved as a result of the mediation.	1	2	3	4	5
f. I am satisfied with the results of the mediation.	1	2	3	4	5
g. The mediators were fair and impartial.	1	2	3	4	5
h. The mediators helped everyone listen, communicate, and stay focused.	1	2	3	4	5
i. The mediators helped identify common and compatible interests of the parties.	1	2	3	4	5
j. The mediators helped keep discussions objective and rational.	1	2	3	4	5
k. The Department of the Interior should continue to make mediation available.	1	2	3	4	5
l. Whether the issues were resolved or not, this mediation was worth the time and effort	1	2	3	4	5
m. I recommend mediation to others in situations similar to the one addressed in this mediation.	1	2	3	4	5
n. I recommend mediation in appropriate workplace disputes, grievances, complaints. or conflicts.	1	2	3	4	5

4. What recommendations, if any, do you have for preventing nonproductive conflict and/or improving conflict resolution in your organization?

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5. How much money or time, if any, would you estimate the government will save as a result of this mediation?

_________________________________________________________________

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6. In what ways, if any, is the work environment likely to improve as a result of this mediation?

_________________________________________________________________

_________________________________________________________________

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7. What do you see as the advantages and disadvantages of the mediation process?

_________________________________________________________________

_________________________________________________________________

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8. How could this mediation have been conducted (or structured) in a way that would have been more helpful in resolving the issues?

_________________________________________________________________

_________________________________________________________________

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_____________________ Your Name and Title	_____________________ Bureau/Office	________________ Date
_____________________ Month /Year of Mediation	_____________________ Name of Mediator(s)
___________________________________ Name(s) of Other Party(ies)in the Mediation