Evaluation form mediation General Filled in by* About the mediation process How satisfied are you with the mediation process? Make a choice very unsatisfied unsatisfied satisfied very satisfied How satisfied are you with the results achieved by the parties? Make a choice very unsatisfied unsatisfied satisfied very satisfied Is your conflict (largely) resolved as a result of the mediation? Make a choice yes no Apart from the outcome of the mediation, did you find participation in the mediation worthwhile? Make a choice yes no How satisfied are you with the total duration of the mediation procedure? Make a choice very unsatisfied unsatisfied satisfied very satisfied How satisfied are you with the mediator's costs? Make a choice not relevant very unsatisfied unsatisfied satisfied very satisfied About the mediator What is the name of the mediator you are evaluating?* —Please choose an option—mr. drs. Caroline Kloppersmr. Nienke Wiersmamr. Dirk-Jan BenderMark Veermansmr. Renate Kerkhofmr. Roos LouwenMarcel FierensGiel JanssensPeter Kelleter How satisfied are you with the impartiality of the mediator? Make a choice very unsatisfied unsatisfied satisfied very satisfied How satisfied are you with the independence of the mediator? Make a choice very unsatisfied unsatisfied satisfied very satisfied How satisfied are you with the mediator's commitment /effectiveness? Make a choice very unsatisfied unsatisfied satisfied very satisfied How satisfied are you with the mediator's diligence? Make a choice very unsatisfied unsatisfied satisfied very satisfied How satisfied are you with the mediator's carefulness? Make a choice very unsatisfied unsatisfied satisfied very satisfied How satisfied are you with the mediator's involvement? Make a choice very unsatisfied unsatisfied satisfied very satisfied What skills have you considered to be decisive in the course and outcome of mediation? Would you recommend this mediator to others? Make a choice yes no Finally Do you prefer an oral evaluation? Make a choice Yes, please by telephone Yes, please an evaluation face-to-face nee, bedankt Do you have any further comments? NB. For example: Explanation of your evaluation or tips / suggestions for your mediator about what could have been different / better during the mediation. May we use your comment (made anonymous)? Make a choice Yes, with only my function and line of business no