Form 3320 0004(1) 3320 0004(1) Mediation Services Participant Questionnaire Rev 2012

OMB Number: 3320-0004
Approval Expiry Date:

Mediation Participant Evaluation
(Agreement Seeking)
The U.S. Institute for Environmental Conflict Resolution requests your assistance in evaluating this
process. As a part of this evaluation we ask the various participants who have been involved in this
project to provide us with information about their experience. The data compiled will be used to
improve future mediation and facilitation processes. The average estimated reporting burden for this
questionnaire is 18 minutes. This estimate includes time for reviewing the instructions, gathering the
data needed, completing, and reviewing the questionnaire. Send comments regarding this burden
estimate or any other aspect of this collection of information, including suggestions for reducing this
burden, to the Institute. The Institute will not report information from this evaluation in a way that
respondents or their organizations can be identified. Moreover, the identity of individual respondents
will be kept confidential and will not be disclosed. The Office of Management and Budget (OMB)
number that is displayed on the cover is currently valid and authorizes this collection of information.

1. Please indicate the extent to which agreement was reached.

TO ANSWER THIS QUESTION,
THINK ABOUT WHAT IT WAS THAT THE GROUP WAS CHARGED TO COME UP WITH AT THE END OF THIS
COLLABORATIVE PROCESS.

The term “AGREEMENT” applies to the written or unwritten agreement reached by participants in
the process, including plans, proposals/recommendations, procedures, collaborative decisions to
work together and settlements.
Check only one


Agreement reached on all key issues



Agreement on most key issues



Agreement on some key issues



No agreement on any key issues, but
progress was made towards addressing
the issues or resolving the conflict.



No agreement, we ended the process
without making much progress.

Use the space below if you would like
to elaborate on your response:

Rating Scale
0
1
Not at all

2

3

4

5
Moderately

6

7

8

9
10
Completely

2. Using the scale above, rate the following statement regarding the agreement (as referred to
in #1).
 PLEASE CHECK HERE IF NOT APPLICABLE (I.E., NO AGREEMENT WAS REACHED)
OTHERWISE, PLEASE RATE THE FOLLOWING.
Rating
a. The extent to which you feel that the agreement reached takes account of
____
your key interests.
____

b. The extent to which the agreement reached will effectively solve the
problem/resolve the conflict.

____

c. The extent to which you are confident the agreement can be implemented.

3. If an assisted collaborative process had not been used, what would have been the most likely
approach to working to address this issue(s)?
Check only one


a. Unassisted negotiation



b. Judicial settlement conference



c. Litigation



d. Lobbying or working to achieve legislative action



e. Rulemaking



f. Arbitration



g. Administrative proceeding (e.g., agency appeals process, contested process
hearing, agency order)



h. Wait for a better time to take action.



i. Don't know



j. Other (PLEASE SPECIFY) ____________________________

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4. Please consider how the collaborative process you completed compares with the alternative
that you identified in the previous question. Select the option that reflects your best estimate
of the costs of the collaborative process compared to the alternative.
Check
only one


The collaborative process was likely less expensive



The collaborative process was likely more expensive



The costs of the collaborative process were likely about the same as the costs of the
alternative

5. Were the benefits from the process worth the time and money you/your organization
invested?
Check only one


Yes



No



Don’t Know

6. Using the scale from the previous page, how do you think the collaborative process you
completed would compare with the alternative that you selected in the question 3?
 Check here if "Not Applicable" (i.e., I selected "Don't Know" for question 3)
Rating
____
____

a. The results of the collaborative process better served my interests.
b. The results of the collaborative process are less likely to be challenged.

____

c. The participants are more likely to be able to work together in the future on
matters related to this case or project.

____

d. The collaborative process we participated in more effectively addressed the
issues or resolved the conflict.

____

e. The collaborative process we participated in led or will lead to a more
informed public action / decision.

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Rating Scale
0
1
Do not agree
at all

2

3

4

5
Moderately
agree

6

7

8

9
10
Completely
agree

7. Using the scale at the top of the page, please rate the extent to which the following
conditions were in place (1) when the process began and (2) as a result of the process.
Before the
process began
Rating

As a result of
the process
Rating

a. The participants were able to work together
cooperatively.  Check if don’t know

_____

_____

b. The participants trusted each other.
 Check if don’t know

_____

_____

c. The other parties had legitimate interests that needed
to be addressed.

_____

_____

8. Please identify the key factors important to your decision whether to participate in this
facilitated/mediated process.
Check the
Most
Important

Check the
Second Most
Important





a. Ability to have confidential discussions





b. Fairness of process





c. Necessary parties would participate





d. Sufficient trust of other parties





e. Prospects for reaching agreement





f. Initial conversations (sometimes called situation or
conflict assessments) with a process facilitator/mediator





g. A change in factors outside my control (e.g., court order,
agency decision) Please specify: __________________





h. Other, please specify:___________________________

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Rating Scale

0
1
Do not agree
at all

2

3

4

5
Moderately
agree

6

7

8

9
10
Completely
agree

9. Using the above scale, please rate your level of agreement with the following:
Rating
a. I had the resources (e.g., time, money) needed to participate effectively in the
____
process.
b. The participants, as a group, felt they were appropriately engaged in designing the
____
process.
 Check if “Don’t Know” or “Not Applicable”
c. I was involved as needed in selecting the mediator(s)/facilitator(s).
____
 Check if “Not Applicable”
d. As a result of early conversations with the mediator/facilitator we were able to
make an informed decision on whether a collaborative process could help us meet
____
our goals.
 Check if Not Applicable
____

e. The participants, as a group, represented all affected concerns.

____

f. The participants had sufficient authority to make commitments on behalf of their
organizations.

____

g. The participants continued to be engaged as long as their involvement was needed.

____

h. The process helped you gain a better understanding of the other participants’ views
and perspectives.
i. The process helped you identify and focus on the key issues that had to be
addressed.

____

j. The participants, as a group, sought options or solutions that met the common
needs of all participants.

____

k. The process enabled participants to be civil to each other.

____

10. Using the scale above, please rate your level of agreement with the following:
Rating
____

a. I had sufficient access to relevant information I needed in order to participate effectively in
this collaborative process.

____

b. Information technology tools (e.g., a project web site was used to share information, spatial
analysis and decision support tools were used) were effectively used.

 Check if Not Applicable
____

c. I gained useful information as a result of participation in the process.

____

d. The quality of the information used was sufficient to support the group’s discussions and
decision making.

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Rating Scale

0
1
Do not agree
at all

2

3

4

5
Moderately
agree

6

7

8

9
10
Completely
agree

11. Using the scale above, please rate the following for each of the mediators/facilitators
involved in this process:
Please identify each mediator/facilitator by placing their initials in the space provided, and then rate each
statement for each mediator/facilitator. Please use the margins to rate additional mediators/facilitators if needed.

Initials of
Mediator(s) /
Facilitator(s)
1. __ 2. __ 3. __

Mediator/Facilitator Skills and Practices

Ratings
____

____

____

a. The mediator/facilitator kept us on track and helped us find ways to move
forward constructively.

____

____

____

b. The mediator/facilitator helped us manage technical discussions efficiently.
 Check if Not Applicable

____

____

____ c. The mediator/facilitator dealt with all participants in a fair & unbiased
manner, and made sure that no one dominated the process.

____

____

____ d. I trusted the mediator/facilitator.

____

____

____

____

____

____ f. The mediator/facilitator made sure that my views and perspectives were
considered in the process.

____

____

____ g. The mediator/facilitator helped the participants test the practicality of the
options under discussion.

____

____

____ h. The mediator/facilitator was helpful in documenting our work.
 Check if Not Applicable (e.g. no agreement)

____

____

____ i. On reflection, this was the right mediator/facilitator to guide the process.

e. I was comfortable with the level of confidentiality in my discussions with
the mediator/facilitator.  Check if Not Applicable

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12. Using the scale from the prior page, please rate your agreement with the following statement.
Rating
____

a. I had communication with the mediator/facilitator that did not include all parties, and
helped me resolve an issue important for advancing the process.
 Check if Not Applicable

If yes, please elaborate on how the communication contributed to advancing the process:
________________________________________________________________________
________________________________________________________________________

13. Using the scale from the prior page, please rate your agreement with the following
statements:
Rating
____

a. I would recommend this type of process to colleagues in a similar situation.

____

b. We could not have progressed as far using any other approach of which I am aware.

____

c. The group could not have progressed as far without the help of a mediator/facilitator.

14. Overall, what did this collaborative process accomplish?
Check the
Most
Important

Check the
Second Most
Important





a. A potentially costly or divisive dispute was likely avoided.





b. An impasse (stalemate) was broken.





c. A crisis was likely averted.





d. Conflict didn’t escalate.





e. Costly or protracted litigation was likely avoided.





f. Relationships among parties in this process were improved.





g. The process resulted in timely decisions and outcomes.





h. Nothing was accomplished.





i. The process made the issues or dispute worse.
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15. From your perspective, what will be the effects (e.g., impacts or benefits) of the progress
made? PLEASE RANK THE MOST IMPORTANT EFFECTS (E.G., 1ST MOST IMPORTANT, 2ND MOST
IMPORTANT). PLEASE ALSO BRIEFLY DESCRIBE THE EFFECTS.
Rank all
that apply

Briefly describe the effects of the progress made:



Natural resources and
environmental conditions



Historic and cultural
resources



Community and social
conditions



Economic conditions



Recreational uses



Other

16. What is your top suggestion on how this collaborative process could have been improved?
PLEASE WRITE "NONE" IF YOU FEEL THIS PROCESS COULD NOT HAVE BEEN IMPROVED .
________________________________________________________________________
________________________________________________________________________

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17. Which category best describes the interest or organization you represented in this process?
CHECK THE MOST APPROPRIATE BOX ONLY .


a. Federal Government



b. State Government



c. Local/County/Regional Government



d. Tribal Government



e. Environmental/Conservation



f. Recreational



g. Industrial/Resource Extraction



h. Business/Commercial



i. Community or Private Citizen (e.g., neighborhood association, local resident)



j. Special Advocacy Interests (Please specify): ____________________



k. Other (Please specify): ______________________________________

18. Please use the space below for any additional comments you would like to make.
________________________________________________________________________
________________________________________________________________________

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