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Office of Equal Employment Opportunity
and
Diversity Management

Conflict Prevention and Resolution
Reference Guide and Mediation Plan
2004

TABLE OF CONTENTS

Section 1 Policy Statement

Section 2 Introduction

Section 3 Incentives for Using ADR Strategies 

Section 4 Ensuring Internal Neutrality 

Section 5 Labor/Management Partnership 

Section 6 Implementation and Procedures

6.1 Selection and Appointment of Agency Mediators

6.2 Information/Training

6.3 CPR Standard Operating Procedures

6.4 Mediation Procedures

Section 7 Roles of Participants in the Mediation Program

7.1 EEO Counselors

7.2 Management/Settlement Official(s)

7.3 Aggrieved Person

7.4 Representatives

7.5 Unions

Section 8 Monitoring and Evaluating the Mediation Process

Appendices

 Section 1 Policy Statement for Conflict Prevention and Resolution Staff

The Conflict Prevention and Resolution (CPR) program was created as an alternative resource to existing formal grievance and EEO complaint processes to address work-related issues. One of the primary goals of CPR is to provide employees with an impartial, confidential avenue to resolve disputes in order to minimize the escalation of disputes to the formal grievance process.

The CPR Specialists offer FDA employees and managers the following resources:

• Mediation -- assisted negotiation with a neutral third party
• Facilitation -- one-on-one or group problem solving, structured dialogue and meeting management to assist groups in achieving desired outcomes
• Consultation -- assists with managing difficult situations
• Training and presentations -- provides information and continuing education about conflict resolution strategies and prevention techniques
• Early Neutral Evaluations -- assesses issues presented and offers recommendations for addressing these issues in an impartial, non-adversarial way

CPR Specialists are trained in all statutory regulations for filing formal grievances (negotiated and administrative), EEO and appeals to the MSPB. All mandated timeframes are strictly adhered to in accordance with the specific statutes. For example, a union grievance must be filed within 30 days of the alleged incident. EEO complaints must be filed within 45 days of the point of incident. Specialists help employees to candidly discuss issues and explore options. They then work to assist the parties to achieve fair and equitable solutions as well as triaging to other available resources. If the employee files an EEO complaint and elects mediation during the pre-complaint stage, management is required to participate in the process. Both management and the employee are entitled to representation during the mediation session. If an employee has not filed a formal grievance/EEO complaint, he/she can request informal ADR assistance (facilitation, counseling, coaching, etc.). A facilitated meeting must take place with the concurrence of both parties, and is intended to informally resolve issues in conflict without moving into a formal arena. Although the facilitated sessions are informal and representation is not typically a part of this process, if any party requests representation, the CPR Specialist will be informed in advance.

If facilitation, mediation, etc. is requested, the unit making the request will be responsible for travel and lodging expenses, if necessary.

Section 2 Introduction

The Food and Drug Administration (FDA) Office of Equal Employment Opportunity and Diversity Management (OEEODM)/Conflict Prevention and Resolution (CPR), has designed an Alternative Dispute Resolution (ADR) program for informal and non-adversarial resolution of complaints of employment discrimination, and as an alternative to litigation or administrative adjudication. The Equal Employment Opportunity Commission (EEOC) urges all Federal government agencies to attempt resolution of complaints of discrimination at the earliest possible stage of the EEO complaint process. EEOC's Federal Sector Equal Employment Opportunity regulations at 29 CFR Part 1614.102(b)(2) require that Federal agencies "...establish or make available an alternative dispute resolution program. Such a program must be available for both the pre-complaint and formal complaint process." Under this regulation, during the EEO counseling period the aggrieved party is given the option of pursuing his/her claim through traditional counseling or engaging in ADR. The pre-complaint counseling period for individuals involved in ADR is 90 days. The ADR process however, is not a substitute for any formal procedure for resolving complaints of discrimination (e.g., those contained in 29 CFR 1614 or the negotiated grievance procedure under the collective bargaining agreement). If complaint is not resolved via CPR, then complaint may proceed through the established process.

The ADR process is offered in order to facilitate resolution of work place conflicts, to restore some control in the management of conflict to the disputing parties themselves, to generate increases in the workability of remedies, to decrease costs and delays in resolution, and to minimize formal complaints. The ADR process is comprised of a variety of alternatives to the traditional methods for resolving disputes through litigation and are generally characterized by informality, flexibility, and control by the parties to the dispute. The FDA has chosen Mediation, the most widely used ADR process in the Federal Sector, as the ADR method of resolving employment discrimination disputes. Mediation is an integral part of EEO complaints processing under 29 CFR Part 1614.

The CPR program utilizes the following ADR strategies in resolving work place disputes informally: facilitation, consultation, training, coaching, early neutral evaluation and counseling.

Mediation is the classic form of assisted resolution where a neutral third party (the mediator) assists the disputing parties to achieve a mutually acceptable agreement. The decision-making authority always rests with the disputing parties. The role of the mediator is to assist the disputing parties in identifying the essential nature of the dispute and in exploring possible avenues for resolution. The mediator cannot force or make binding decisions on behalf of either party. Rather, the objective of the mediator is to bridge the gap in communication between the disputing parties and assist them in reaching a voluntary agreement of their own. All communications between the mediator and the disputing parties are held as confidential to the maximum extent possible except in cases of fraud, abuse, or criminal activity.

Section 3 Incentives for Using ADR Strategies

To assist in understanding ADR in general and mediation in particular, and to promote its use, where appropriate, the following benefits of its use have been identified:

The process:

• is fair;
• creates a win/win situation;
• helps maintain or improve working relationships;
• does not require extensive documentation or witnesses;
• is private;
• reduces tension;
• reduces time and costs;
• is non-adversarial;
• improves the individual's sense of well being;
• involves management, unions and employees;
• empowers the disputing parties to control their fate;
• produces lasting results more often;
• opens lines of communication; and
• increases creativity and productivity.

Section 4 Ensuring Internal Neutrality

The mediation process must be fair, non-discriminatory, confidential and non-threatening. It must be based on criteria and standards of fairness which are clear and understandable. It is a process that is easily accessible to everybody, regardless of position, grade or status. The mediation process must be conducted by neutral parties who have no stake in the outcome of the dispute. No party involved in the mediation process will be coerced into signing a settlement agreement.

Section 5 Labor/Management Partnership

The FDA is committed to implementing a CPR program that will best serve all FDA employees. When a person is employed by an agency subject to 5 U.S.C. 7121(d) and is covered by the collective bargaining agreement that permits allegations of discrimination to be raised in a negotiated grievance procedure, a person wishing to file a complaint on a matter of alleged employment discrimination must elect to raise the matter under either 29 CFR Part 1614 or the negotiated grievance procedure, but not both. However, the CPR program provides early intervention strategies to assist in possible resolution of issues before they are raised in a formal grievance or EEO complaint process.

Section 6 Implementation and Procedures

6.1 Selection and Appointment of Agency Mediators

The CPR Staff is comprised of full time, certified mediators. However, contract and collateral-duty mediators are also utilized. FDA collateral-duty mediators are selected through a competitive process and trained on an ongoing basis. Subsequently, collateral-duty mediators are appointed by the Director, CPR to serve for one-year collateral-duty assignments, as third-party neutrals to assist in the resolution of employment disputes.

6.2 Information/Training

Information is made available to all employees to raise awareness/knowledge of the alternative dispute resolution process and procedures through briefings, orientation sessions and informational material. The CPR program is responsible for the implementation and monitoring of all information/educational activities and training. Internal training programs are conducted by CPR staff and private consultants to train collateral-duty mediators. Additionally, a mentoring program has been established to assist new mediators through co-mediation assignments and through the Department of Health and Human Services' Sharing Neutrals.

6.3 CPR Standard Operating Procedures (for standard intake)

The FDA has chosen Mediation as the ADR method of resolving employment discrimination complaints. However, many workplace issues are not found to be EEO related. When this is the case, the following ADR strategies are recommended (facilitation, coaching, counseling, etc.) in addition to Mediation.

When an employee/manager is confronted with a non-EEO related issue, he/she can contact the CPR office for assistance.

1. The first point of contact with the CPR is through the CPR Program Specialist. This individual will be available to answer questions, concerns, advice, and setting up an appointment for a more in-depth meeting, mediation, facilitation, etc. The employee or supervisor counseled will also be made aware of the requirements and timeframes within each established grievance procedure. In the event that the concerns or issues are not resolved during mediation, all rights to engage in and file any relevant grievance procedure will be retained;
2. After the first contact, the CPR Program Specialist or Mediator fills out an Intake Form. These forms would contain basic information about the individual who contacted or visited the CPR, and a brief explanation of the conflict;
3. The CPR Program Specialist or Mediator then makes an appointment with the individual, if there is need for a more in-depth meeting, follow-up meeting, mediation, facilitation, etc., as the CPR Program Specialist or Mediator sees fit. An additional Mediator can be requested; and/or even from an alternate resource such as free HHS shared neutrals program;
4. If upon initial contact or first in-depth meeting, the conflict or concern is not resolved, the CPR Program Specialist will act a fact-finder, shuttle diplomat, mediator, facilitator, and/or educate others in order to get to the root cause of the conflict and resolve it. Doing so may involve subsequent meetings and involve more individuals to get involved. However, no action to involve others will be exercised, without the consent of the individuals who first contacted the CPR, unless another individual also involved in the same conflict decides to approach and contact the CPR on their own behalf. We are also obliged to report any full incident of fraud, waste, and abuse;
5. The CPR Program Specialist may then, with consent, provide advice, education and a recommendation to others affecting the problem. As some options fail to work, or are considered inappropriate, or unwise, the CPR Program Specialist may recommend an alternative approach to use, but will consult the CPR visitor for consent on the recommendation. The CPR Program Specialist may continue to change his/her approach and seek advice from other resources, until the conflict is resolved or the case closed;
6. Case closure may occur if the customer decides to stop any other formal attempt to resolve the conflict, and/or the deadline before having to file a grievance or EEO complaint approaches;
7. The CPR Program Specialist will take general notes during his/her actions to bring resolution to the conflict. These notes will be used by the CPR's Program Specialist, to analyze the root cause of the conflict, and record the cause for evaluation purposes;
8. The CPR Program Specialist will follow-up where necessary to make sure that the conflict is resolved;
9. Any agreements made between the parties of a conflict, which results in a resolution, will be reduced to writing in the form of an agreement in principle;
10. The CPR Program Specialist will collect data from the mediators (the causes of the conflict), and then analyze it for patterns and trends. A periodic report will be created to act as a feedback mechanism to the agency, to change, improve policies, management practices, and procedures, and increase productivity in the workplace.

6.4 Mediation Procedures

The following is a summary of the procedures to be followed in scheduling mediations within the EEO complaint process:

STEP 1: At the pre-complaint counseling stage, the aggrieved party is given the option by an EEO Counselor to go through mediation or to pursue traditional EEO counseling to resolve disputes. Requests for mediation are referred by OEEODM EEO Counselor to CPR Program Coordinator for processing (see Appendix 1 for Referral Form to Mediate ).

STEP 2: CPR Program Coordinator will oversee and coordinate all activities related to the process, i.e., assignment of a mediator(s), providing guidance and support to the mediator(s) and coordinating all logistical needs.

STEP 3: Prior to the first session, the designated mediator(s) will make initial contact with the parties to the dispute. This provides an opportunity for the mediator(s) to get acquainted with the parties and to briefly explain the mediation process.

STEP 4: A commitment to participate in the mediation process will be secured from the aggrieved person and the management official(s) (see Appendix 2 for Agreement to Mediate ). If an aggrieved party elects to mediate, in lieu of traditional counseling, management will participate.

STEP 5: The CPR Program Coordinator(s) and the mediator(s) will make all necessary arrangements for conducting the mediation session(s).

STEP 6: The mediator(s) will conduct the mediation session(s), and have sole authority over the process. They will also ensure confidentiality, including the destruction of all written materials generated during the mediation session(s).

STEP 7: If the mediation process results in a resolution, the terms of agreement are reduced to writing using the Memorandum of Agreement used in any EEO case (see Appendix 3 for Memorandum of Agreement ). The draft agreement will be initialed by the aggrieved person/complainant, management/ settlement official(s) and transmitted to the appropriate individuals for review and approval.

STEP 8: The agreement becomes final once signed by the Director, OEEODM.

STEP 9: If either or both parties request that mediation cease, or if the mediator(s) recommends that mediation be terminated, a Request to Discontinue Mediation must be completed (see Appendix 4 Request to Discontinue Mediation ). Copies of the signed request are given to the disputing parties and the original signed copy is sent to the CPR Program Coordinator(s).

STEP 10: If theparties discontinue mediation or if they are unable to reach an agreement, the matter is referred to the CPR Program Coordinator. The Coordinator will inform the OEEODM EEO Counselor to proceed with the completion of the Final Counseling Report and issuance of the Notice of Final Interview and Right to File a Discrimination Complaint.

Section 7 Roles of Participants in the Mediation Program

 7.1 EEO Counselors

The EEO Counselor will advise the aggrieved party of the availability of the Mediation process, provide information on the timeframes involved in the Mediation process, and inform them of their rights and responsibilities. The EEO Counselor will inform the CPR Specialist (Program Coordinator) when the aggrieved party has chosen to mediate a dispute. Once the aggrieved party has opted to participate in the mediation process, the EEO Counselor is precluded from attempting to resolve the matter. If the mediation, however, does not result in resolution of the dispute, the EEO Counselor will prepare a Final Counseling Report and issue a Notice of Final Interview and Right to File a Discrimination Complaint.

7.2 Management/Settlement Official(s)

Agency policy commits Management's participation in the mediation process when an aggrieved party is in the pre-complaint stage of the EEO process. Participation in mediation of formal cases is voluntary. Management/Settlement Official(s) to be involved in the mediation process must have the authority to enter a settlement agreement. Where delegation of authority limits a designee from exercising authority to settle a matter, the appropriate Management/Settlement Official(s) with settlement authority, will be involved in the process.

Management/Settlement Official(s) involved in the mediation process must:

• Negotiate in good faith;
• Explore settlement options prior to participating in the mediation session(s).
• Resources are available to provide technical guidance through the Office of Human Resources Management and Services and the OEEODM;
• Where settlement is reached, approve and sign settlement agreement; and
• When the settlement agreement is approved, ensure implementation of terms of the agreement in a timely manner.

7.3 Aggrieved Person

The Aggrieved person is an individual who is an employee, former employee or an applicant for employment who has made allegation(s) of employment discrimination. The aggrieved person is afforded the opportunity to seek resolution for such claims through the EEO complaints process. The aggrieved must:

• Clearly state a claim and the basis for the claim;
• Choose between traditionally counseling for mediation of the dispute;
• Negotiate in good faith;
• Designee a representative (not mandatory); and
• If settlement is reached, approve and sign the settlement agreement.

7.4 Representatives

The aggrieved person has the right to choose to be accompanied in mediation by the advisor of his/her choice in order to assist and lend support. While it is not necessary to have an attorney or other representative in order to participate in FDA's Mediation Program, either party may choose to have one. The mediator will decide what role the attorney or representative will play during the mediation. The mediator may ask or provide advice and counsel, but not speak for the party. If a party plans to bring an attorney or other representative to the mediation session(s), he or she must discuss this with the Mediation Program Coordinator prior to the start of the mediation process. The Management Official may elect to have representation during the mediation process (e.g., Employee Relations, Personnel Specialist, Office of General Counsel Representative, etc.).

7.5 Unions

Mediation session(s) held during the course of formal complaints are considered formal discussions. Thus, according to the provisions of the Collective Bargaining Agreement between FDA and the National Treasury Employees Union (NTEU), the Union has the right to be present during the mediation session(s), whether selected by the aggrieved person or not. They are bound by the same confidentiality requirement as the parties.

Section 8 Monitoring and Evaluating the Mediation Process

 The CPR Staff is responsible for ongoing monitoring of the mediation process and the annual evaluation of the program. Evaluation forms (see Appendix 5 for Evaluation Forms )will be distributed to the parties involved in mediation. The data collected in the evaluations specifically relate to processing not to the substance of a dispute. Such data are used to make improvements and modifications to the FDA Mediation Process.

Appendices

Appendix 1 Referral Form to Mediate

Appendix 2 Agreement to Mediate

Appendix 3 Memorandum of Agreement

Appendix 4 Request to Discontinue Mediation

Appendix 5 FDA Mediation Evaluation Forms

Appendix 6 Mediator Debriefing Form

 APPENDIX 1
FDA REFERRAL FORM TO MEDIATE  

OEEODM
Revised 03/2004

APPENDIX 2
AGREEMENT TO MEDIATE

The parties agree to engage in mediation to try to resolve issues raised during the alleged employment discrimination complaint process. The parties agree to participate in the mediation process in good faith. The parties understand that mediation may be ended at any time by any of the parties. If an employee elects mediation during the pre-complaint stage, management is required to participate. Both management and the employee are entitled to representation during the mediation process.

The parties understand that the mediator(s) is a neutral third-party. As such, the mediator(s) has no authority to settle the dispute and is not acting as advocate or attorney for any party.

All communications between the mediator(s) and the disputing parties are held confidential to the maximum extent possible except in cases of fraud, abuse, or criminal activity. Any documents submitted to the mediator(s) and any statements made during the mediation are for resolution purposes only. The parties agree to maintain the information discussed or the documents presented confidential and the parties will also hold the fact that the mediation took place confidential. The parties agree not to subpoena the mediator(s) or any documents prepared by or submitted to the mediator(s). In no event will the mediator(s) voluntarily testify for any party or submit any type of report concerning this mediation. Confidentiality will not extend to threats of imminent physical harm.

No party is bound by anything said or done at the mediation session(s) unless an agreement is reached and executed by all parties. If an agreement is reached, it will be reduced to writing as a draft. It will become binding when signed by all parties and approved by the Director, Office of Equal Employment Opportunity and Diversity Management (OEEODM), FDA. The Director of OEEODM may have changes to be made to the draft and the parties may be required to approve and signed amended versions of the draft.

The parties agree that the mediator(s) has the right to end the mediation at any time if the mediator(s) feels that further discussions would not be helpful in resolving the dispute.

By signature below, we acknowledge that we have read, understand, and agree to this mediation process.

__________________________________________________
Aggrieved Person/Complainant

__________________________________________________
Representative

__________________________________________________
Management/Settlement Official

__________________________________________________
Representative

__________________________________________________
Mediator

__________________________________________________
Co-Mediator

OEEDM
Revised 03/2004

APPENDIX 3
NEGOTIATED SETTLEMENT, RELEASE AND CONFIDENTIALITY AGREEMENT
FDA-_____________
_________________________v. DHHS

The Negotiated Settlement, Release and Confidentiality Agreement, hereinafter referred to as "Agreement," is made and entered into by and between the Parties, hereinafter referred to as "Complainant" or "Aggrieved Party" and the Food and Drug Administration, Department of Health and Human Services, hereinafter referred to as "Agency" or "DHHS ." This agreement is the result of a mediation process that took place on________________, prior to the Complainant/Aggrieved Party filing an informal Complaint of Discrimination.

In exchange for the terms contained herein, the Agency and Complainant/Aggrieved Party voluntarily agree and stipulate as follows:

1. First Agreed Term
   
   
   
2. Second Agreed Term
   
   
   
3. Third Agreed Term
   
   
   
4. Full Settlement
   In consideration for the management actions provided in paragraph #1, the Complainant agrees that these terms are in full settlement (including, but not limited to, claims for back pay, attorneys fees, costs, monetary damages and other form of relief) of all her pending EEO claims regarding his/her employment at FDA that arose up to the signing of this Agreement. Complainant agrees not to file a complaint, grievance, charge, appeal, action, or suit against the DHHS, or any officer, employee or component thereof, with respect to any action which is related to or arises out of his/her employment with FDA and which occurred prior to the effective date of this Agreement. By signing this Agreement, Complainant withdraws and dismisses with prejudice all pending EEO complaints, MSPB Appeals, grievances, charges, appeals, actions, or suits filed against DHHS or any of its components.
   
5. Implementation of this Agreement
   The FDA Office of Equal Employment Opportunity and Diversity Management (OEEODM) will monitor this Agreement to ensure that all parties abide by its terms and conditions. The parties shall follow the procedures as set forth in 29 C.F.R. Section 1614.504 (2000) in the event of a failure by the Agency to carry out the terms of the Agreement. As set forth at 29 C.F.R. Section 1614, if either party believes that the opposing party has breached any term of this settlement Agreement, the non-breaching party shall notify and furnish supporting documentation to the Director, OEEODM, FDA, within 30 calendar days of the date that the non-breaching party knew or should have known of the alleged noncompliance. The Director, OEEODM, will review the matter, make a determination as to whether a breach occurred, and notify both parties of such decision.
   
6. Confidentiality
   The parties and signatories agree that the terms of this Agreement will be confidential and that they will not divulge the contents of this Agreement to anybody other than its signatories, or other individuals who are required to implement one or more of its terms. The Complainant is permitted to speak to his/her attorney, tax preparer, accountant, or other financial advisors, tax authorities, potential lenders, and his/her immediate family about the terms of this Agreement. Subject to this exception, the parties are permitted to state only that all issues between the parties have been resolved.
   
7. Use of this Agreement
   The Complainant agrees that he/she will not use and will not permit any other person to use, this Agreement, or the fact of this Agreement, in any administrative or judicial proceeding as evidence of or to prove the existence of discrimination, retaliation, or any other prohibited personnel practice, by DHHS or any of its components or employees.
   
8. No Admission
   The parties hereto understand that this Agreement is to be regarded as a "no-fault" settlement and, as such, is not intended, and will not be construed by either party, to constitute an admission or statement by either party as to the validity or invalidity of any legal position or factual contention advanced in the above-referenced matters by either issues raised in these complaints.
   
9. Sole Agreement
   The terms set forth in this Agreement constitute the complete understanding between the parties. The Agreement may not be modified except by written amendment signed by both parties.
   
10. Effective Date of this Agreement
    By signing this Agreement, Complainant understands that he/she is knowingly and voluntarily waiving any rights and claims that he/she may have arising under the Age Discrimination in Employment Act as amended by the Older Workers Benefit Protection Act.
    
    Complainant understands that:
    
    1. He/She does not waive rights or claims that may arise after the effective date of this Agreement;
    2. He/She waives rights and claims only in exchange for consideration;
    3. He/She is advised to consult with an attorney prior to signing this Agreement;
    4. He/She has twenty-one (21) days in which to consider this Agreement before signing it; but, if he/she signs this Agreement before the twenty-one (21) day time period has expired, he/she attests that his/her decision to accept such a shortening of this period is knowing and voluntary and was not induced by the Agency through fraud, misrepresentation, and/or threats to withdraw or alter the terms of the Agreement.
    5. He/She may revoke this Agreement within seven (7) days of the date on which he/she signs the Agreement, and this Agreement is not effective until the seven (7) day revocation period has expired and all signatures have been obtained;
    6. He/She may revoke this Agreement by delivering written notice of revocation to the Director, FDA Office of Equal Employment Opportunity and Diversity Management, no later than the final day of the expiration period, at the following address:
       
       U.S. Department of Health and Human Services
       Food and Drug Administration
       Office of Equal Employment Opportunity and Diversity Management
       Parklawn Building
       5600 Fishers Lane Room 8-72
       Rockville, Maryland 20857 ; and
       
    7. If he/she revokes this Agreement, it shall not be effective or enforceable and he/she will not receive the benefits described above in paragraph 1.
       
11. Where Breach is Found
    If the OEEODM Director determines that the Agency has violated the terms of this Agreement, Complainant's remedies shall be as set forth at 29 C.F.R. Section 1614.504. In the event that the OEEODM Director finds that Complainant/Aggrieved Party has violated the Agreement, the Agency shall have the right to recover from Complainant all monies paid to him/her as a result of the terms of this Agreement, utilizing, if necessary, the procedures and rights set forth at 45 C.F.R. Part 30. The Agency may also rescind any other non-monetary relief provided in this Agreement, in order to restore the parties to the position that they were in immediately prior to the effective date of this Agreement. Further, if Complainant violates any terms of this Agreement, he/she may not reinstate this complaint before the agency, the Equal Employment Opportunity Commission, or any other administrative, legislative, or judicial body.
    
12. Understanding of Terms
    All of the parties to this Agreement have fully read the terms of this Agreement and have had the opportunity to discuss the terms with their attorney. Each signature below signifies an understanding of the terms contained in this Agreement and a voluntary acceptance of the terms contained herein.

APPENDIX 4
Request to Discontinue Mediation

Date:___________________

NOTE TO: EEO Counselor or Complaints Specialist

Re: Case Name(s) and Number(s):________________________________________

___________________________________________________________________

I _________________________________ hereby request that mediation efforts be discontinued effective on (date)________________.

Signature of party requesting that mediation be discontinued:

_______________________________________________________________________
Aggrieved Person/Complainant Date

_______________________________________________________________________
Management/Settlement Official Date

_______________________________________________________________________
Mediator Date

_______________________________________________________________________
Mediator Date

APPENDIX 5
FDA MEDIATION EVALUATION FORM

(ALL PARTIES)

PURPOSE: It is our objective to present useful and effective services. You are the final authority on whether that objective has been met. Your completion of this form, therefore, will play an important part in our future planning and help us do a better job. Please do not feel bound to limit your remarks to questions on this form. Your pertinent comments on any aspect of the service will be appreciated.

I. Please answer Yes or No to the following:

II. Overview of Mediation:

Name of Mediator(s):_____________________________________________________________

Name of Participant:_____________________________________________________________

Date(s) of Mediation Session(s)_____________________________________________________

Outcome: Settled_______ Not Settled_________ Discontinued_____________

Please complete and fax back to (301) 827-9661.

APPENDIX 6
MEDIATOR DEBRIEFING FORM

We would like to know if this process was useful and valuable to you. Your evaluation can help us improve the quality of CPR's service and ensure that the service meets your needs. Your pertinent comments on any aspect of the service will be appreciated.

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