Form 3320-0004(1) Mediation Services - Participant Questionnaire (Paper)

OMB Number: 3320-0004
Approval Expiry Date: xx/xx/xx

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 20 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.
This questionnaire has an identifying number so that we can track who has responded. 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. Which category best describes the interest or organization you represented in this process?
CHECK THE MOST APPROPRIATE BOX ONLY.
F

a. Federal Government

F

b. State Government

F

c. Local/Regional Government

F

d. Tribal Government

F

e. Environmental/Conservation

F

f. Recreational

F

g. Industrial/Resource Extraction

F

h. Business/Commercial

F

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

F

j. Special Advocacy Interests (Please specify): ____________________

F

k. Other (Please specify): ______________________________________

2. 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
F

Agreement reached on all key issues

F

Agreement on most key issues

F

Agreement on some key issues

F

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

F

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

3. Using the scale above, rate the following statement regarding the agreement (as referred to in #2).
F

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 the agreement reached takes account of all key
interests.

____

b. The extent to which you feel that the agreement reached takes account of your
key interests.

____

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

____

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

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4. If you had not participated in this collaborative process, what would have been the most likely
process for the issues to be addressed or resolved?
Check only one

5.

F

a. Unassisted negotiation

F

b. Judicial settlement conference

F

c. Litigation

F

d. Lobbying or working to achieve legislative action

F

e. Rulemaking

F

f. Arbitration

F

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

F

h. Wait for a better time to take action.

F

i. Don't know

F

j. Other (PLEASE SPECIFY) ____________________________

Please consider how the collaborative process you completed compares with the alternative
that you identified in the previous question, and then check the most appropriate of the
following:
Check
only
one
F

I feel the collaborative process was less expensive….and this level of expenditure was appropriate.

F

I feel the collaborative process was less expensive…but additional resources were probably needed.

F

I feel the collaborative process cost more…. and the extra costs were worth the investment.

F

I feel the collaborative process cost more…and the extra costs were not worth the investment.

F

Don’t know

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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

6. Using the scale above, how do you think the collaborative process you completed would
compare with the alternative that you selected in the question 4? Although it may be hard to
know what would have happened with the alternative you chose in question 4, please give us you
thoughts on the following:
F Check here if "Not Applicable" (i.e., I selected "Don't Know" for question 4)
Rating
____

a. The results of the collaborative process better served the interests of the
participants.

____

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.

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.

_____

_____

b. The participants trusted each other.
F Check if Don't know or no experience

_____

_____

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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

8. 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. F Check if “Don’t Know” or “Not Applicable”

____

c. I was involved as needed in selecting the mediator(s)/facilitator(s).
F Check if “Not Applicable”

____

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

____

e. The absence of participants had a negative effect on the collaborative process.
F Check if "Not Applicable" (i.e. no participants were absent)

____

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

____

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

____

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 process helped the participants, as a group, effectively engage to work on the key
issues.
k. The participants, as a group, sought options or solutions that met the common needs of
all participants.

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

a. We worked effectively to identify information needs.

____

b. All participants had full access to relevant information they needed in order to participate
effectively in this collaborative process.

____

c. The quality of the information used was good enough for the outcomes of the process.

____

d. Relevant information was effectively integrated into the process (e.g., a project web site was
used to share information, spatial analysis and decision support tools were used).

____

e. The agreement(s) reached were improved as a result of information integrated into the process.

F Check if "Not Applicable" (i.e. no agreement was reached)
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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

10. Using the scale above, please rate the following for each of the mediators/facilitators (if more
than one) 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. On reflection, this was the right mediator(s)/facilitator(s) to
guide the process.

____

____

____

b. The mediator(s)/facilitator(s) kept us on track and proceeding in
a timely manner.

____

____

____

c. The mediator/facilitator helped us manage technical discussions
efficiently.
F Check if Not Applicable

____

____

____

d. The mediator(s)/facilitator(s) dealt with all the participants in a
fair and unbiased manner.

____

____

____

e. When things got tense, the mediator(s)/facilitator(s) was able to
help us find ways to move forward constructively.
F Check if Not Applicable

____

____

____

f. The mediator(s)/facilitator(s) made sure that the views and
perspectives of all participants were considered in the process.

____

____

____

g. The mediator(s)/facilitator(s) made sure that no one dominated
the process or other participants.

____

____

____

h. The mediator(s)/facilitator(s) helped the participants test the
practicality of the options under discussion.

____

____

____

i. The mediator(s)/facilitator(s) was helpful in documenting our
agreement(s). F Check if Not Applicable (e.g. no agreement)

___

___

___

j. The group could not have progressed as far without the help of
the mediator(s)/facilitator(s).
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11. Think back to the start of the process and please rate the following using the scale from the
prior page:
F
Rating
____

CHECK HERE IF NOT APPLICABLE (I.E., I WAS NOT INVOLVED AT THE START OF THE PROCESS)

a. At the start of the process, I was willing to work cooperatively with other
participants in this process.

12. 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
without hesitation.

____

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

13. At this point in time, in very general terms what did this collaborative process accomplish?
Check all that apply
a. A potentially costly or divisive dispute was likely avoided.
F
F

b. An impasse (stalemate) was broken.

F

c. A crisis was averted.

F

d. Conflict didn’t escalate.

F

e. Costly or protracted litigation was avoided.

F

f. Relationships among parties in this process were improved.

F

g. The process resulted in timely decisions and outcomes

F

h. Nothing was accomplished.

F

i. The process made the issues or dispute worse.

14. 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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15. From your perspective, what will be the effect (e.g., impacts or benefits) of the agreement
reached or progress made? PLEASE WRITE “NONE” IF NOT APPLICABLE, OTHERWISE PLEASE IDENTIFY
EFFECTS IN THE CATEGORIES LISTED BELOW AND/OR ADD YOUR OWN CATEGORIES AS APPROPRIATE.
Effects of the agreement reached or progress made
Natural resources and
environmental conditions

__________________________________________________
__________________________________________________

Historic and cultural
resources

__________________________________________________
__________________________________________________

Community and social
conditions

__________________________________________________
__________________________________________________

Economic conditions
__________________________________________________
__________________________________________________
Recreational uses
__________________________________________________
__________________________________________________
Other, please specify
__________________________________________________

__________________________________________________

Thank you for taking the time to complete this questionnaire.
Your assistance in providing this information is very much appreciated.

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