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 LouwenGiel 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