Feedback Request Form
This Feedback Request will take just 10 minutes to complete
Every IMI Certified Professional Mediator has attained a high standard of professional competency in the practice of mediation. On completion of each mediation, the Mediator will invite the participants to complete this Feedback Request Form. Your feedback will:
- Help future users to have more information about working with this Mediator
- Provide the Mediator with an opportunity to know your perception of the mediation process on this occasion, how effective (s)he was, and why, and
- Enable the Mediator’s Peer Reviewer to prepare the Mediator’s Feedback Digest which is a professional requirement of all IMI Certified Mediators.
You may complete this Feedback Request Form in handwritten form or fill in electronic form and send it to the Reviewer responsible for preparing the Mediator’s Feedback Digest. If you prefer, you may also give it to the Mediator for forwarding to the Reviewer. As the Feedback Digest is prepared by the Mediator’s Reviewer, it should contain an objective and independent summary of the content of previously-submitted forms. The Feedback Digest may be relied upon by other parties in the future in deciding whether to appoint this Mediator, so please try to be fair and helpful as possible in providing your comments. Please try not to be influenced unduly by the outcome of your mediation but to focus on the Mediator him/herself and on any particular contributions that (s)he may have made that you found to be especially important.
You are welcome to see an example of Feedback completed by a Party in an actual case.
The Mediator’s task is a challenging one. In your responses, please try to appreciate this and to be specific and constructive as possible. It would be helpful if you could include your name and details on the last page so that you can be contacted by the Reviewer in the unlikely event that clarification is needed. Please be assured that your information, and any information about the mediation, will remain confidential and will not be provided to third parties.
Name of Mediator:
Mediation Institution (if any):
Start Date of Mediation:
End date of Mediation:
Place of Mediation:
Nature of mediated matter:
Please check the appropriate boxes, below and add any comments you wish to make.
Summary Questions
1. On a scale of 1-5 (1 = low; 5 = high), how likely are you to use this Mediator again?
1 2 3 4 5 Not Applicable
Comment:
2. Would you recommend this Mediator to others?
Yes No Not sure
Comment: (If Yes, why? If No, why not?)
Comment:
Specific Questions
4. How did you identify or appoint this mediator?
a. IMI web portal
b. Suggested by a colleague, law firm or other professional
d. Suggested by one of the other parties
5. If you perceive that the Mediator’s skills made a decisive difference in the outcome, which particular skills were they?
Comment:
6. How satisfied are you with the costs of the mediator?
(1=very dissatisfied; 2=dissatisfied; 3=neutral; 4=satisfied; 5=very satisfied)
Comment:
7. How do you rate your overall satisfaction with the mediation process and the result obtained by the parties?
(1=very dissatisfied; 2=dissatisfied; 3=neutral; 4=satisfied; 5=very satisfied)
Comment:
8. If a dispute resolution organization was involved in the selection and appointment of the mediator, please indicate how you rate your overall satisfaction with that body's support of the dispute resolution process?
(1=very dissatisfied; 2=dissatisfied; 3=neutral; 4=satisfied; 5=very satisfied)
1 2 3 4 5 Not Applicable
9. Did you resolve most of your issues as a result of the mediation?
Independently of whether the mediation resulted in a resolution, what was worthwhile about participating in mediation?
Comment:
10. Was this your first experience with the mediation process?
Yes No
11. Are you willing to be mentioned as a reference on this Mediator’s IMI Profile on the IMI web portal?
Yes No
Your responses on this form will be treated as confidential information by the Reviewer and by the Mediator but may be referred to in an anonymous form (ie. without any reference to the parties or any other information identifying you or your mediation) in the Mediator’s Feedback Digest on the IMI web portal.
Thank you for completing this Feedback Request.
It will help others in the future.
If you are willing to disclose your name and contact details, please do so below:
Name:
Organization:
Position:
Phone:
Email:
