Form 3320-0003(1) Assessment Services - Initiator Questionnaire (Paper)

OMB Number: 3320-0003
Approval Expiry Date: xx/xx/xxxx

Assessment Evaluation (Key Participants)
The U.S. Institute for Environmental Conflict Resolution evaluates all of its services. As a part of this
evaluation we ask the various interests who have been involved in an Institute project or case to provide us
with information about their experience. Your responses will be part of the Institute’s ongoing evaluation
effort, and the data compiled will provide much-needed information that will be used to improve our
programs and services. The average estimated reporting burden for this questionnaire is 6 minutes. This
estimate includes time for reviewing the instructions, 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.

1.

What was the general recommendation in the assessment regarding whether or not to
proceed with this situation/controversy?
Check
only one
F
F

2.

a. Proceed with one or more of the recommended approaches to collaboration
(e.g., mediation, facilitation, or other approach)

b. Do not proceed with a collaborative process at this time

Was the general recommendation followed?
Check
only one

F

Please identify the key factors that have or
likely will influence this decision:

Yes, we have or likely will

Uncertain
F

No
F

1

Rating Scale
0

1

2

3

4

Do not agree
at all

5

6

7

8

Moderately
agree

9

10
Completely
agree

3. Using the scale above, please rate the extent to which you agree with the following
statements about the assessment.
Rating
____

a. Key issues were explored.

____

b. Key issues were considered in the final recommendations.

____

c. Input was sought from key parties to the situation/controversy.

____

d. I would use a situation/conflict assessment again for similar situations.

4. Using the scale above, please rate the extent to which you agree with the following statement:
Rating
____

a. The U.S. Institute’s services (including the contractor services) helped us
determine how best to proceed to solve this problem/resolve this conflict.

5. Please describe anything that stood out to you that added to or detracted from the
effectiveness of this assessment.
__________________________________________________________________________
__________________________________________________________________________

6. Do you have any recommendations as to how future assessment processes or products could
be improved?
__________________________________________________________________________
__________________________________________________________________________

7. Do you have any additional comments that you would like to add?

___________________________________________________________
___________________________________________________________

THANK YOU FOR TAKING THE TIME TO COMPLETE THIS QUESTIONNAIRE.

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