# Shared Neutrals Program

A guide to Alternative Dispute Resolution

under the Federal Executive Board of Minnesota's

Interagency Voluntary Mediation Process

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Federal Executive Board of Minnesota

Room 510 Bishop Henry Whipple Federal Building

1 Federal Drive

Fort Snelling, Minnesota 55111-4058

February 2001

**FEDERAL EXECUTIVE BOARD OF MINNESOTA**

**SHARED NEUTRALS PROGRAM**

The Shared Neutrals Program of Minnesota is a program of the Federal
Executive Board of Minnesota to provide mediation as an alternative
method to resolve workplace disputes. The combined resources of the
Federal community will be shared to provide interagency mediators. The
program's goal is to resolve workplace disputes at the earliest possible
date. Early resolution will result in improved communication within the
workforce, a more productive work environment, and reduced cost and time
in resolving disputes.

**I. What is Mediation?**

Mediation is an informal method of resolving disputes with a fellow
employee, manager or colleague. In mediation, a neutral person (a
mediator) helps two or more persons explore ways to resolve their
differences and reach an agreement to best address their interests.
Neither party surrenders legal rights or entitlements when using the
Shared Neutrals Program. All parties must be willing to resolve the
problem for the process to be successful. Mediation, unlike arbitration
or court proceedings, has no focus on "placing blame." The mediator has
no authority to force a decision on the parties involved. Those involved
in the dispute decide what is important and make decisions based on
those factors. A mediator assists the parties in becoming
"decision-makers." This process establishes communication which, in
turn, leads to increased understanding and allows the participants to
create options and solutions to address their concerns.

**II. What is the Value of Mediation?**

Mediation allows the participants an opportunity to tell their story and
be heard. This process allows the persons affected to create their own
solutions and examine unique resolutions to a problem, instead of
referring the problem to a judge, arbitrator or another outside
decision-maker. The participants thereby retain more control in
developing realistic and mutually satisfactory solutions.

## When Should Mediation be Considered?

Mediation may be used in most cases of workplace disagreement, including
discrimination complaints, grievances, and other forms of disputes on a
case-by-case basis.

This process should not be considered in cases involving criminal
activity, government policy, interpretation of collective bargaining
contract language, and cases expected to take over 35 hours to mediate.

### IV. Agency Participation

A signed **Agency** **Agreement to Participate (Form A)** qualifies an
agency to draw from the roster. The agency must also identify an
**Agency Coordinator** to serve as a liaison between the Federal
Executive Board and the agency. The agency should also identify specific
forms they would like to see used (if different from those included in
this Handbook), who within the agency is authorized to request a
mediation (if different from the Agency Coordinator); and other
requirements of the agency. All of these agency-specific items are
subject to review and approval by the Shared Neutrals Council.

In the first year of their commitment, participating agencies are not
required to contribute a mediator in order to draw from the Roster.
Agencies may instead contribute meeting space, logistical support,
training funds, printing or other support. In the second year, most
agencies will be encouraged to contribute a mediator to the Roster.
Exceptions can be negotiated with the Shared Neutrals Council.

The most important contribution an agency can make to the program is to
provide cases for mediation.

### V. Shared Neutrals Council

The Shared Neutrals Council is the governing body for the FEB of
Minnesota's Shared Neutrals Program. Seven to ten members will be
appointed by the FEB and will include representatives of member
agencies. The Executive Director of the FEB of Minnesota will serve as
an ad hoc member of the council.

Membership should include the following groups: mediators, agency
coordinators, and union representatives. Responsibilities include:
review and supervision of the roster, case intake, data collection and
analysis, outreach (making sure people understand the program is
available), systems analysis (continually improving structure of the
program), program development (making other types of ADR available),
mediator education (orientation, requests for training courses,
opportunity to co-mediate), observation (evaluation of mediators), and
planning and conducting an annual meeting for the mediators.

At the beginning of each year, the Council will elect a Chair and
Vice-Chair from the members of the Council. The Council Chair and
Vice-Chair will serve for a one year period beginning on January 1st.
Recording duties will be rotated between members.

#### Council Member Terms

The standard term length for Council members will be two years. Initial
term lengths should be staggered in six-month increments so that
turn-over is gradual. Individual Council member terms will begin on
either January 1^st^ or June 1^st^ of each year. No member will serve
more than one term unless an exception is granted by the Executive
Director of the FEB of Minnesota in order to maintain the efficiency and
continuity of Council activities. Former Council members may be
appointed to a new two-year term after a one year absence from the
Council.

#### Decision-Making

The group will make decisions on a consensus basis, using the following
decision-making process.

1\. All substantive issues will be brought to the Council for decision.

2\. Decision making does not rest with any one agency or individual, but
rather is a collective process among the Council members.

3\. The Council will make decisions via consensus (defined as \"a
collective opinion arrived at by a group working in an environment that
permits open communication so that each person feels s/he has a fair
chance to speak\"). While the Council will strive for unanimous
affirmative decisions, consensus will also include the possibility of
one or more members being willing to at least accept (as opposed to
fully agreeing with) a given choice.

> 4\. All reasonable effort will be made to obtain consensus.
>
> 5\. Since consensus relies heavily on discussion and understanding,
> absent members cannot vote by proxy, but they can send someone to
> participate in the consensus process.
>
> 6\. The Council can decide to table an issue to allow for additional
> discussion and/or time for reflection.
>
> 7\. Once consensus is reached on a given issue, that issue will not be
> readdressed unless there is a consensus decision to do so.
>
> 8\. Members will abide by the decision(s) made in their absence.

##### C. Council Member Responsibilities

> 1\. Follow through to the best of their ability on the work they agree
> to accomplish, and to come to meetings prepared.
>
> 2\. Be responsible for ensuring s/he has the authority needed from
> their own agency to represent that agency\'s view.
>
> 3\. Participate fully, and to raise issues, concerns, and opinions as
> they arise.
>
> 4\. All reasonable effort will be made to provide advanced information
> on issues to be decided.

5\. Meetings will start on time.

### VI. Who are the Mediators?

###### A. The Roster

A Roster of Mediators will be prepared and maintained by the Shared
Neutrals Council. The Roster will include persons who meet the following
requirements:

1.  Designated by a participating agency;

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2.  Complete a **Mediator Application (Form J)**. This application
    includes questions regarding the applicant's education and training,
    work background, availability, and interest in mediation;

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3.  Demonstrate an ongoing participation and interest in mediation;

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4.  At least 24 hours of formal mediation training. Persons who have
    already completed this requirement are not required to complete
    additional training;

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5.  Complete a program orientation. Program orientations will be
    provided as part of an annual meeting of program mediators, as part
    of the formal mediation training offered through FEB to new
    mediators, or as otherwise offered by the Shared Neutrals Council;

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6.  Meet established mediation experience requirements:

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a.  Persons who have completed five or more solo mediations will be
    included on the Roster;

b.  All other applicants will be expected to observe mediations
    conducted by an experienced mediator, and then mediate disputes
    under the observation of an experienced mediator. Based on
    evaluations by the experienced mediator and evidence that they meet
    the other program requirements, the Shared Neutrals Council will
    approve individuals for inclusion on the Roster.

7\. Subscribe to specified ethical standards as described below.

8\. Complete no less than six (6) hours of approved continuing education
each year addressing alternative dispute resolution.

###### B. Training Requirements

In order to qualify for inclusion on the FEB Shared Neutrals roster, all
mediator applicants are required to complete at least 24 hours of
approved formal training, with an emphasis on experiential learning. The
training must include both lecture and role-playing. The following
topics must be addressed:

1.  Conflict resolution and mediation theory, including the causes of
    conflict, interest-based versus positional bargaining, and models of
    conflict resolution.

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2.  Mediation skills and techniques including information gathering
    skills, communication skills, problem-solving skills, interaction
    skills, conflict management skills, negotiation techniques, causing,
    cultural and gender issues and power balancing.

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3.  Components in the mediation process, including an introduction to
    the mediation process, fact gathering, interest identification,
    option building, problem solving, agreement building, decision
    making, closure, drafting agreements, and evaluation of the
    mediation process.

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4.  Mediator conduct, including conflicts of interest, confidentiality,
    neutrality, and ethics.

###### C. Annual Continuing Education Requirement for Mediators

In order to maintain and develop conflict resolution skills, all
mediators listed on the FEB Shared Neutrals roster must annually
complete not less than six (6) hours of continuing professional
education in the alternative dispute resolution field. The Shared
Neutrals Council will conduct at least one (1) annual training
conference for all mediators and coordinators that will satisfy the
continuing professional education requirement. Mediators may satisfy the
continuing education requirement through attendance in training
sponsored by outside agencies, however, proof of completion must be
provided to the Shared Neutrals Council. Whether continuing education is
completed through the FEB sponsored training conference or through
training sponsored by other agencies, all mediators must complete the
**Mediator Continuing Education** form **(Form J1)** and return it to
the Shared Neutrals Council no later than December 31^st^ of each
calendar year. Mediators who have not completed the continuing education
requirement will be listed as "inactive" on the FEB Shared Neutrals
roster.

###### D. Conduct Standards

The conduct of mediators in this program will be governed by the
following standards:

1.  **Self-Determination:** Self-determination is the fundamental
    principle of mediation. It requires that the mediation process rely
    upon the ability of the parties to reach a voluntary, uncoerced
    agreement. Any party may withdraw from mediation at any time.

2\. **Impartiality:** A mediator shall mediate only those matters in
which she/he can remain impartial and evenhanded. If at any time the
mediator is unable to conduct the process in an impartial manner, he/she
is obligated to withdraw.

3\. **Conflicts of Interest***:* A conflict of interest is any action or
relationship that might create an impression of possible bias. The basic
approach to questions of conflict of interest is consistent with the
concept of self-determination. The mediator has a responsibility to
disclose all actual and potential conflicts that are reasonably known
and could reasonably be seen as raising a question about impartiality.

4\. **Competence:** A mediator will mediate only when he/she has the
necessary qualifications to satisfy the reasonable expectations of the
parties.

5\. **Confidentiality***:* A mediator will maintain the reasonable
expectations of the parties with regard to confidentiality.

6\. **Quality of the Process:** A mediator shall conduct the mediation
fairly, diligently, and in a manner consistent with the principle of
self-determination.

### VII Who Are the Agency Coordinators?

The Agency Coordinator manages the distribution of information about the
availability of mediation within the agency and how the FEB Shared
Neutrals Program can be used. The information will include details on
the process for making referrals for mediation to the Agency
Coordinator, such as, who can make them, how to make them, and other
details of the process. See **Form D** in the Forms Appendix.

### VIII How Does the Mediation Process Work?

A. The Agency Coordinator contacts the FEB Shared Neutrals Program at
(612) 713-7200. A member of the Council will return the call and ask for
the following:

-   target date(s) for mediation

-   copy of signed **Request for Mediation Services (Form B)**

B. The Shared Neutrals Council assigns a mediator.

C.  The assigned mediator contacts the disputants and the Agency
    Coordinator to schedule the time and place for mediation.

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1.  The time will depend on the availability of both the disputants and
    the mediator.

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2.  The place is to be arranged in coordination with all parties. The
    Agency Coordinator is responsible for coordination and for assuring
    that the designated site is properly equipped with flipcharts,
    refreshments, etc.

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3.  Issues of confidentiality and the willingness of the disputants to
    participate in the mediation process excludes observers, other than
    representatives, from sitting in on any stage of mediation, unless
    approved in advance by the mediator and agreed upon by all parties
    to the mediation.

> 4\. Representatives: Each party may bring one representative to act as
> an advisor in the mediation process. Parties have a free choice of
> representative and are responsible for any representative expenses
> involved. If a party elects representation, the representative's name
> and phone number will be identified on the **Request for Mediation
> (Form B)**. Representatives must also sign the **Agreement to Mediate
> (Form C)** prior to participating in the mediation. In all cases that
> settle, the representatives of the parties will also sign the
> **Settlement Agreement (Form F).** Parties are responsible for all
> arrangements and expenses related to the appearance of their
> representatives at the mediation.

D.  The Agency Coordinator will ensure that the mediators are provided
    with any necessary agency background information, including
    identifying likely agency officials who are authorized to make a
    decision on the dispute.

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E.  The Agency Coordinator will assist the mediator in contacting the
    officials necessary to authorize the agreement.

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F.  The follow-up and documentation of the mediation process will
    include:

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1.  Scheduling of a follow-up mediation session as necessary.

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2.  If a settlement is reached, documentation of the settlement
    agreement with approving signatures of participants and
    representatives (if present). **(Settlement Agreement - Form F)**

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3.  Evaluation of the process by participants and mediator(s).
    **(Participant Survey - Form G; Mediator Evaluation of Process -
    Form H)** Completed forms evaluating the process are maintained by
    the FEB Shared Neutrals Council in a sanitized form only. (i.e., all
    identifying information is deleted)

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4.  If a settlement is reached, copies of the **Settlement Agreement
    (Form F)** are provided to each participant. One copy is maintained
    by the Agency Coordinator.

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5.  A Mediator Survey is completed and submitted to the FEB Shared
    Neutrals Council within five business days after the completion of
    the mediation. **(Mediator Evaluation of Process - Form H)**

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6.  All notes are destroyed.

####### Settlement

1.  A settlement is only binding if approved and signed by all
    disputants and, as necessary, by appropriate agency officials.

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2.  When agency approval and/or action is required, only officials with
    delegated settlement authority may enter into a settlement.

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3.  A completed settlement agreement will be maintained by the Agency
    Coordinator.

Federal Executive Board of Minnesota

February, 2001

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Federal Executive Board of Minnesota - Shared Neutrals Program

# Forms Appendix

The following forms were developed for use in the Shared Neutrals
Program:

> Form A Agency Agreement to Participate
>
> Form B Request for Mediation Services
>
> Form C Agreement to Mediate
>
> Form C1 Program Information
>
> Form D Agency Coordinator Checklist
>
> Form E Mediator Checklist
>
> Form F Settlement Agreement
>
> Form G Participant Survey
>
> Form H Mediator Evaluation of Process
>
> Form I Agency Evaluation of Program
>
> Form J Mediator Application
>
> Form J1 Mediator Continuing Education
>
> Form K Mediator Trainee Evaluation

  ---------------------------------------------------- ------ ------ ---- ------------ -------------
  ![](media/image1.wmf){width="0.6972222222222222in"                                   FORM A
  height="0.6756944444444445in"}                                                       

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> Federal Executive Board of Minnesota - Shared Neutrals Program

# Agency Agreement to Participate

> By signing below, I assert that I have authority to represent that:
>
> \[NAME OF AGENCY\]
>
> hereinafter "the Agency" agrees to participate in the project on
> sharing Neutrals.
>
> As such, the Agency agrees to:

-   assign an Agency Coordinator to serve as a contact point for the
    Shared Neutrals Program.

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-   Abide by principles of confidentiality, as outlined in Section 4 of
    the Administrative Dispute Resolution Act, 5 U.S.C. 574 (as amended
    from time to time), and the "Agreement to Mediate."

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-   assist in obtaining appropriate facilities for meetings with the
    disputants.

-   local travel expenses will be at the expense of the mediator's
    agency. Travel outside the mediator's commuting area will be paid by
    the agency requesting mediation services.

-   the mediator's salary will be paid by his or her agency. No other
    compensation is required.

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-   Parties who choose to withdraw from mediation will not be subject to
    retailiation.

It is understood that by signing this document the Agency does not in
any way compromise its authority to control the work schedule of any
employee who is acting as a mediator under this program.

  ----------------------------------- ---- -------------------------------
                                           

  Authorized Agency Official               Date

                                           

                                           

  Title                                    Agency Address and Telephone
  ----------------------------------- ---- -------------------------------

  ---------------------------------------------------- ------ ------ ---- ------------ -------------
  ![](media/image1.wmf){width="0.6972222222222222in"                                   FORM B
  height="0.6756944444444445in"}                                                       

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Federal Executive Board of Minnesota - Shared Neutrals Program

# Request for Mediation Services

  -------- -------------------- ------------------ ------------------------ --------------- ------------------
  **1.**   **NAME (Last, First,                    **POSITION (Title, Grade                 
           MI)**                                   and Series)**                            

                                                                                            

                                                                                            

  **2.**   **EMPLOYING AGENCY**                    **COMPONENT/DIVISION**                   

                                                                                            

                                                                                            

  **3.**   **PLACE OF                              **PHONE NUMBER AT WHICH                  
           EMPLOYMENT (Address,                    YOU WISH TO BE                           
           City, State, Zip                        CONTACTED**                              
           Code)**                                                                          

                                                                                            

                                                                                            

                                                   **EMAIL ADDRESS**                        

                                                                                            

  **4.**   **REPRESENTATIVE'S                                                               
           NAME AND TELEPHONE                                                               
           NUMBER**                                                                         

                                                                                            

  **5.**   **NAME OF OTHER                                                                  
           PARTIES AND                                                                      
           TELEPHONE NUMBERS                                                                
           (Please identify                                                                 
           Position and                                                                     
           Title)**                                                                         

                                                                                            

                                                                                            

                                                                                            

  **6.**   **HAVE YOU INITIATED                                                             
           A FORMAL OR INFORMAL                                                             
           EEO COMPLAINT OR                                                                 
           OTHER GRIEVANCE                                                                  
           THROUGH ONE OF YOUR                                                              
           AGENCY'S                                                                         
           ADMINISTRATIVE                                                                   
           GRIEVANCE OR                                                                     
           COMPLAINT                                                                        
           PROCEDURES?**                                                                    

                                                                                            

  **7.**   **ISSUE FOR                                                                      
           MEDIATION \[Please                                                               
           describe the issues                                                              
           you are requesting                                                               
           be mediated - If                                                                 
           more space is                                                                    
           needed, please                                                                   
           attach additional                                                                
           sheets to this                                                                   
           form.**                                                                          

                                                                                            

                                                                                            

                                                                                            

  **8.**   **RESOLUTION                                                                     
           REQUESTED (Attach                                                                
           additional pages if                                                              
           needed)**                                                                        

                                                                                            

                                                                                            

                                                                                            

  **9.**   **SIGNATURE OF PARTY                                             **DATE SIGNED** 
           REQUESTING                                                                       
           MEDIATION**                                                                      

                                                                                            
  -------- -------------------- ------------------ ------------------------ --------------- ------------------

**Privacy Act Statement:** The collection of this information is
authorized by 5 U.S.C. 574. This information will be used to assign a
mediator to your case. As a routine use, this information may be
disclosed to a congressional office at your request; to OMB for review
of private relief legislation; to a labor organization as required by
the NLRA or FLRA; where pertinent in a legal proceeding to which the
government is a party; to an appropriate law enforcement agency for
investigative or prosecutorial purposes; to a government agency where
relevant to a hiring, contracting, or licensing decision by the
requesting agency; to a government agency in order to elicit information
relevant to a hiring, contracting, or licensing decision by the
government; to an expert or consultant under contract with the
government to fulfill an agency function; to the Federal Records Center
for storage; to the Equal Employment Opportunity Commission for
investigating a formal EEO complaint filed under 29 C.F.R. 1614; to the
Merit Systems Protection Board or Office of Special Counsel for
proceedings involving possible prohibited personnel practices. The
completion of this form is voluntary; however, if this information is
not provided, you may not have your case mediated by a Shared Neutrals
panel mediator.

  --- --------------------------------- ---------------------------------
      **FEB USE ONLY**                  

      **DATE RECEIVED BY FEB SHARED     **CASE NUMBER**
      NEUTRALS COUNCIL**                

                                        

      **NAME OF MEDIATOR ASSIGNED**     **DATE MEDIATOR ASSIGNED**

                                        
  --- --------------------------------- ---------------------------------

THIS FORM WILL BE DESTROYED AT THE CONCLUSION OF THE MEDIATION

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  ![](media/image1.wmf){width="0.6972222222222222in"                                   FORM C1
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> Federal Executive Board of Minnesota - Shared Neutrals Program

# Mediation Program Information

**Mediation Under Shared Neutrals Program**

**Impartial Process:** Mediation is a process in which an impartial
third party that has no authority to decide the issue or impose a
resolution assists the parties in exploring a mutually-satisfactory
resolution of the issues in dispute. At all times the decision to settle
or impasse the dispute is solely within the hands of the parties. The
mediator does not decide the dispute and has no authority to force
either party to resolve the dispute. The role of the mediator is to help
the parties understand each other's positions, interests and
perspectives and assist the parties in deciding whether the dispute can
be resolved. The mediator also encourages mutual respect between the
parties and takes the steps necessary to prevent any abuse of the
mediation process. The impartial mediators for this pilot program are
trained and experienced in alternative dispute resolution. Under the
program, the parties pay no fees to participate in the mediation
conference.

**Confidential Process:** Besides limited legal requirements to report
certain kinds of information, mediation is a confidential process.
Mediators may not directly or indirectly disclose information
communicated to them by a party during mediation to anyone who is not a
party to the mediation. Additionally, a mediator may not disclose
information communicated in confidence by a party to the other party
without permission. This confidentiality is critical to the mediation
process and mediators will not willingly testify about anything they
hear in the course of a mediation and will contest subpoenas or orders
seeking to require their appearance or testimony in subsequent
proceedings. After the conclusion of the mediation, mediators retain no
files relating to the mediation and are required to destroy any notes
they take during the mediation session.

**Mediation Process:** A typical mediation features an opening statement
by the mediator outlining the mediation process and the roles of the
mediator and parties. Both parties will be given an opportunity to
explain their position on the matter in dispute. There will also be
joint discussion between the parties concerning the issues with
assistance of the mediator. There may also be one or more private
meetings between the mediator and one or the other parties. These
meetings are know as caucuses and are used to explore issues in greater
detail. The mediator will not share matters discussed in the caucus with
the other party without permission. If the parties' discussions result
in a resolution, the mediator will assist the parties to commit their
agreement to writing. All settlements are between the parties. The
mediator is not a party to any settlement agreement.

**For More Information:** If you have questions about mediation in
general or the procedures to be used during this pilot program in
particular, please call your agency program coordinator.

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  ![](media/image1.wmf){width="0.6972222222222222in"                                   FORM D
  height="0.6756944444444445in"}                                                       

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> Federal Executive Board of Minnesota - Shared Neutrals Program

# Agency Coordinator Checklist

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|   |   |   | m |                                                                |
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|   |   |   | s |                                                                |
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|   |   |   | m |                                                                |
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|   |   |   | d |                                                                |
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|   |   |   | l |                                                                |
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|   |   |   | e |                                                                |
|   |   |   | s |                                                                |
|   |   |   | . |                                                                |
+---+---+---+---+----------------------------------------------------------------+
|   |   |   |   |                                                                |
+---+---+---+---+----------------------------------------------------------------+
|   |   |   | I |                                                                |
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|   |   |   | a |                                                                |
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+---+---+---+---+----------------------------------------------------------------+
|   |   |   | C |                                                                |
|   |   |   | o |                                                                |
|   |   |   | u |                                                                |
|   |   |   | n |                                                                |
|   |   |   | c |                                                                |
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|   |   |   | o |                                                                |
|   |   |   | n |                                                                |
|   |   |   | : |                                                                |
+---+---+---+---+----------------------------------------------------------------+
|   |   |   |   |                                                                |
+---+---+---+---+----------------------------------------------------------------+
|   |   |   | - |                                                                |
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|   |   |   |   |                                                                |
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|   |   |   |   |                                                                |
|   |   |   |   |                                                                |
|   |   |   | * |                                                                |
|   |   |   | * |                                                                |
|   |   |   | R |                                                                |
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|   |   |   | q |                                                                |
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|   |   |   |   |                                                                |
|   |   |   |   |                                                                |
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|   |   |   |   |                                                                |
|   |   |   | M |                                                                |
|   |   |   | e |                                                                |
|   |   |   | d |                                                                |
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|   |   |   | a |                                                                |
|   |   |   | t |                                                                |
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|   |   |   |   |                                                                |
|   |   |   |   |                                                                |
|   |   |   |   |                                                                |
|   |   |   |   |                                                                |
|   |   |   | S |                                                                |
|   |   |   | e |                                                                |
|   |   |   | r |                                                                |
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|   |   |   | i |                                                                |
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|   |   |   | s |                                                                |
|   |   |   |   |                                                                |
|   |   |   |   |                                                                |
|   |   |   |   |                                                                |
|   |   |   |   |                                                                |
|   |   |   | ( |                                                                |
|   |   |   | F |                                                                |
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|   |   |   | r |                                                                |
|   |   |   | m |                                                                |
|   |   |   |   |                                                                |
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|   |   |   |   |                                                                |
|   |   |   |   |                                                                |
|   |   |   | B |                                                                |
|   |   |   | ) |                                                                |
|   |   |   | * |                                                                |
|   |   |   | * |                                                                |
+---+---+---+---+----------------------------------------------------------------+
|   |   |   |   |                                                                |
+---+---+---+---+----------------------------------------------------------------+
|   |   |   | H |                                                                |
|   |   |   | e |                                                                |
|   |   |   | l |                                                                |
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|   |   |   | t |                                                                |
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|   |   |   | t |                                                                |
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|   |   |   | c |                                                                |
|   |   |   | e |                                                                |
|   |   |   | s |                                                                |
|   |   |   | s |                                                                |
|   |   |   | - |                                                                |
+---+---+---+---+----------------------------------------------------------------+
|   |   |   | a |                                                                |
|   |   |   | r |                                                                |
|   |   |   | y |                                                                |
|   |   |   | . |                                                                |
|   |   |   | M |                                                                |
|   |   |   | a |                                                                |
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|   |   |   | t |                                                                |
|   |   |   | h |                                                                |
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|   |   |   | m |                                                                |
|   |   |   | e |                                                                |
|   |   |   | d |                                                                |
|   |   |   | i |                                                                |
|   |   |   | a |                                                                |
|   |   |   | t |                                                                |
|   |   |   | i |                                                                |
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|   |   |   | i |                                                                |
|   |   |   | s |                                                                |
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|   |   |   | p |                                                                |
|   |   |   | e |                                                                |
|   |   |   | r |                                                                |
|   |   |   | l |                                                                |
|   |   |   | y |                                                                |
|   |   |   | e |                                                                |
|   |   |   | q |                                                                |
|   |   |   | u |                                                                |
|   |   |   | i |                                                                |
|   |   |   | p |                                                                |
|   |   |   | p |                                                                |
|   |   |   | e |                                                                |
|   |   |   | d |                                                                |
|   |   |   | . |                                                                |
+---+---+---+---+----------------------------------------------------------------+
|   |   |   |   |                                                                |
+---+---+---+---+----------------------------------------------------------------+
|   |   |   | P |                                                                |
|   |   |   | r |                                                                |
|   |   |   | o |                                                                |
|   |   |   | v |                                                                |
|   |   |   | i |                                                                |
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|   |   |   | h |                                                                |
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|   |   |   | b |                                                                |
|   |   |   | a |                                                                |
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|   |   |   | o |                                                                |
|   |   |   | n |                                                                |
|   |   |   | . |                                                                |
+---+---+---+---+----------------------------------------------------------------+
|   |   |   |   |                                                                |
+---+---+---+---+----------------------------------------------------------------+
|   |   |   | H |                                                                |
|   |   |   | e |                                                                |
|   |   |   | l |                                                                |
|   |   |   | p |                                                                |
|   |   |   | t |                                                                |
|   |   |   | h |                                                                |
|   |   |   | e |                                                                |
|   |   |   | m |                                                                |
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|   |   |   | a |                                                                |
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|   |   |   | r |                                                                |
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|   |   |   | e |                                                                |
|   |   |   | n |                                                                |
|   |   |   | t |                                                                |
|   |   |   | . |                                                                |
+---+---+---+---+----------------------------------------------------------------+
|   |   |   |   |                                                                |
+---+---+---+---+----------------------------------------------------------------+
|   |   |   | M |                                                                |
|   |   |   | a |                                                                |
|   |   |   | i |                                                                |
|   |   |   | n |                                                                |
|   |   |   | t |                                                                |
|   |   |   | a |                                                                |
|   |   |   | i |                                                                |
|   |   |   | n |                                                                |
|   |   |   | a |                                                                |
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|   |   |   | h |                                                                |
|   |   |   | e |                                                                |
|   |   |   | * |                                                                |
|   |   |   | * |                                                                |
|   |   |   | S |                                                                |
|   |   |   | e |                                                                |
|   |   |   | t |                                                                |
|   |   |   | t |                                                                |
|   |   |   | l |                                                                |
|   |   |   | e |                                                                |
|   |   |   | m |                                                                |
|   |   |   | e |                                                                |
|   |   |   | n |                                                                |
|   |   |   | t |                                                                |
|   |   |   | A |                                                                |
|   |   |   | g |                                                                |
|   |   |   | r |                                                                |
|   |   |   | e |                                                                |
|   |   |   | e |                                                                |
|   |   |   | m |                                                                |
|   |   |   | e |                                                                |
|   |   |   | n |                                                                |
|   |   |   | t |                                                                |
|   |   |   | ( |                                                                |
|   |   |   | F |                                                                |
|   |   |   | o |                                                                |
|   |   |   | r |                                                                |
|   |   |   | m |                                                                |
|   |   |   | F |                                                                |
|   |   |   | ) |                                                                |
|   |   |   | * |                                                                |
|   |   |   | * |                                                                |
|   |   |   | . |                                                                |
+---+---+---+---+----------------------------------------------------------------+
|   |   |   |   |                                                                |
+---+---+---+---+----------------------------------------------------------------+
|   |   |   |   | ######## Optional                                              |
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+---+---+---+---+----------------------------------------------------------------+
|   |   |   | p |                                                                |
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|   |   |   | s |                                                                |
|   |   |   | e |                                                                |
|   |   |   | s |                                                                |
|   |   |   | o |                                                                |
|   |   |   | n |                                                                |
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|   |   |   | y |                                                                |
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+---+---+---+---+----------------------------------------------------------------+

  ---------------------------------------------------- ------ ------ ---- ------------ -------------
  ![](media/image1.wmf){width="0.6972222222222222in"                                   FORM E
  height="0.6756944444444445in"}                                                       

  ---------------------------------------------------- ------ ------ ---- ------------ -------------

> Federal Executive Board of Minnesota - Shared Neutrals Program

# Mediator Checklist

**INFORM** parties your opening will take a few minutes and ask them to
relax until you are done.

**INTRODUCE** yourself and the parties. Use first names only if you have
permission from the parties to do so. Introduce observers and explain
their role.

**COMMEND** participants for using mediation.

**REMIND** participants that mediation is a voluntary process.

-   Are the parties present voluntarily? Are there court orders?

-   How were the parties referred?

-   Are all parties required to reach agreement present?

**REMIND** participants that mediation is a CONFIDENTIAL process.

-   Previously unreported abuse (child, elder, disabled, etc.) is an
    exception and must be reported.

-   Mediators cannot be required to testify.

-   All mediator notes will be destroyed.

**DESCRIBE** role of mediator.

-   To be an impartial facilitator, not an advocate, attorney or judge.

-   To assist parties in arriving at their own solutions.

**DESCRIBE** role of Parties.

-   To mediate in good faith, be willing to listen, to share all
    pertinent information, to keep an open mind, be willing to negotiate
    without holding to a fixed position.

-   To abide by rules of common courtesy, no interrupting or using
    inflammatory language.

**EXPLAIN** the process.

-   Client opening statements and response period; emphasis on
    uninterrupted time.

-   Developing an agenda/list of items to discuss.

-   Negotiating *issues* and *interests* or concerns.

-   Caucus (optional). Explain confidentiality and use.

-   Settlement Agreement. Forms: Settlement is the parties' agreement
    and is legally binding. Settlement agreements are enforced by
    courts.

######### MEDIATION AGREEMENT \[Form C\]

-   Give a copy to each side. Read it aloud.

-   Have all sign the original

######### DETERMINE PROPER PARTY TO BEGIN 

  ---------------------------------------------------- ------ ------ ---- ------------ -------------
  ![](media/image1.wmf){width="0.6972222222222222in"                                   FORM F
  height="0.6756944444444445in"}                                                       

  ---------------------------------------------------- ------ ------ ---- ------------ -------------

> Federal Executive Board of Minnesota - Shared Neutrals Program

# Settlement Agreement

We, , , and

having participated in a mediation session (s) on and being satisfied
that we have reached a fair and reasonable resolution, hereby agree as
follows: (attach additional sheets if needed)

  -----------------------------------------------------------------------

  -----------------------------------------------------------------------

We intend, understand, and agree that this agreement is binding on all
participants.

DATED this day of , in the year

  --------------------- ---------- -- ----- ------------------------- -------
                                                                      

  Participant A         Date                Representative -          Date
                                            Participant A             
  --------------------- ---------- -- ----- ------------------------- -------

  --------------------- ---------- -- ----- ------------------------- -------
                                                                      

  Participant B         Date                Representative -          Date
                                            Participant B             
  --------------------- ---------- -- ----- ------------------------- -------

  --------------------- ---------- -- ----- ------------------------- -------
                                                                      

  Participant C         Date                Representative -          Date
                                            Participant C             
  --------------------- ---------- -- ----- ------------------------- -------

  ---------------------------------------------------- ------ ------ ---- ------------ -------------
  ![](media/image1.wmf){width="0.6972222222222222in"                                   FORM G
  height="0.6756944444444445in"}                                                       

  ---------------------------------------------------- ------ ------ ---- ------------ -------------

> Federal Executive Board of Minnesota - Shared Neutrals Program

# Participant Survey

  --------------------------- ------------------ ------------------------
  **MEDIATOR NAME**           **MEDIATION DATE** **MEDIATION LOCATION**

                                                 

                                                 
  --------------------------- ------------------ ------------------------

The purpose of this survey is to determine how the mediation process is
working and what areas need improvement. Your comments are important and
will be kept confidential. Please return this survey in the enclosed
stamped, self-addressed envelope to the Federal Executive Board of
Minnesota's Shared Neutrals Council. Thank you.

Please evaluate the mediation process using the following scale,
describing your satisfaction level:

  -------------- -------------- -------------- -------------- --------------
                                                              

  1              2              3              4              5

  Very           Dissatisfied   Somewhat       Satisfied      Very Satisfied
  Dissatisfied                  Satisfied                     
  -------------- -------------- -------------- -------------- --------------

  ---- -------------- --- ------ --- ---------------- --- ------ ---- --- --- --- ---
                                                                 1    2   3   4   5

  1    How well did                                                               
       the                                                                        
       mediator(s)                                                                
       explain the                                                                
       process to all                                                             
       the parties?                                                               

  2    Were you able                                                              
       to fully                                                                   
       present your                                                               
       case?                                                                      

  3    How well did                                                               
       the                                                                        
       mediator(s)                                                                
       listen?                                                                    

  4    Did the                                                                    
       mediator(s)                                                                
       help create                                                                
       realistic                                                                  
       options for                                                                
       settling the                                                               
       dispute?                                                                   

  5    Was the                                                                    
       mediator(s)                                                                
       impartial?                                                                 

  6    Did the                                                                    
       mediator(s)                                                                
       understand the                                                             
       issues                                                                     
       involved?                                                                  

  7    How well did                                                               
       the                                                                        
       mediator(s)                                                                
       clarify key                                                                
       issues and                                                                 
       interests of                                                               
       each party?                                                                

  8    How satisfied                                                              
       were you with                                                              
       the                                                                        
       mediator(s)?                                                               

  9    How satisfied                                                              
       were you with                                                              
       the outcome of                                                             
       the mediation?                                                             

  10   Did your reach                                                             
       settlement                                                                 
       with your                                                                  
       mediation?                                                                 
       (check below)                                                              

       YES                NO         PARTIAL RESOLVE                              

  11   How beneficial                                                             
       was the use of                                                             
       a neutral                                                                  
       party from                                                                 
       another                                                                    
       federal agency                                                             
       to the early                                                               
       resolution of                                                              
       this matter.                                                               

                                                                                  

  12   Any other                                                                  
       comments or                                                                
       elaboration on                                                             
       any of the                                                                 
       questions                                                                  
       above:                                                                     

                                                                                  

                                                                                  

                                                                                  

                                                                                  

                                                                                  

                                                                                  

                                                                                  
  ---- -------------- --- ------ --- ---------------- --- ------ ---- --- --- --- ---

**THANK YOU FOR TAKING THE TIME TO COMPLETE THIS SURVEY. YOUR RESPONSES
WILL BE INCLUDED IN EVALUATING THE EFFECTIVENESS OF THE FEB SHARED
NEUTRAL PROGRAM. ADDITIONALLY, SURVEY RESPONSES MAY BE SHARED WITH THE
MEDIATORS AND THE FEB SHARED NEUTRALS COUNCIL FOR PROGRAM EVALUATION.
PLEASE RETURN THIS COMPLETED SURVEY TO:**

> FEB SHARED NEUTRALS COUNCIL
>
> ROOM 510 - BISHOP HENRY WHIPPLE FEDERAL BUILDING
>
> 1 FEDERAL DRIVE
>
> FORT SNELLING MN 55111-4058

  ---------------------------------------------------- ------ ------ ---- ------------ -------------
  ![](media/image1.wmf){width="0.6972222222222222in"                                   FORM H
  height="0.6756944444444445in"}                                                       

  ---------------------------------------------------- ------ ------ ---- ------------ -------------

> Federal Executive Board of Minnesota - Shared Neutrals Program

# Mediator Evaluation of Process

To be completed by mediator(s) at the end of mediation conference and
returned to the FEB of Minnesota Shared Neutrals Council.

  ---------------- ---------------- -------------- ------------------ ------------------
  **MEDIATOR 1**                                   **MEDIATOR 2**     

                                                                      

  **EMPLOYING      **LOCATION**     **EMPLOYING                       **LOCATION**
  AGENCY**                          AGENCY**                          

                                                                      

  **HOURLY PAY     **TRAVEL COSTS** **HOURLY PAY                      **TRAVEL COSTS**
  RATE**                            RATE**                            

                                                                      

  **CASE NUMBER**  **AGENCY**       **LOCATION**                      **MEDIATION
                                                                      DATES**

                                                                      

  **OUTCOME OF                                                        
  MEDIATION**                                                         

                                                                      
  ---------------- ---------------- -------------- ------------------ ------------------

Please complete all questions. For additional comments, please continue
on the back of this form.

  ----- -------------------------------------------------------------------
  1\.   Please describe any impacts or benefits that you feel have resulted
        from the mediation process. Examples include repaired working
        relationships, enhanced communication or office productivity, cost
        savings and any other benefit you can identify.

        

  2\.   Explain why the case settled or didn't settle from your view as
        neutral.

        

  3\.   Provide positive or negative comments about process and anything
        unusual about this matter that the FEB Mediation Coordinator and/or
        Shared Neutral Council should be aware of:

        

  4\.   Do you believe mediation was appropriate for this particular
        matter?

        

  5\.   Was the fact that you came from a different Federal Agency to
        facilitate this process helpful or detrimental to the situation?

        

  6\.   Is there anything you can suggest that would improve the Shared
        Neutral Program?

        
  ----- -------------------------------------------------------------------

**THANK YOU FOR TAKING THE TIME TO COMPLETE THIS SURVEY. YOUR RESPONSES
WILL BE INCLUDED IN EVALUATING THE EFFECTIVENESS OF THE FEB SHARED
NEUTRALS PROGRAM. PLEASE RETURN THIS COMPLETED SURVEY TO:**

> FEB SHARED NEUTRALS COUNCIL
>
> ROOM 510 - BISHOP HENRY WHIPPLE FEDERAL BUILDING
>
> 1 FEDERAL DRIVE
>
> FORT SNELLING MN 55111-4058

  ---------------------------------------------------- ------ ------ ---- ------------ -------------
  ![](media/image1.wmf){width="0.6972222222222222in"                                   FORM I
  height="0.6756944444444445in"}                                                       

  ---------------------------------------------------- ------ ------ ---- ------------ -------------

> Federal Executive Board of Minnesota - Shared Neutrals Program

# Agency Evaluation of Process

We are looking to determine the effectiveness of the Federal Executive
Board's Shared Neutrals Program. FEB member agencies who have used the
program are requested to complete this questionnaire. Completing this
evaluation will provide information that will assist us in improving the
program.

  --------------------------------- -------------------------------------
  **NAME OF AGENCY**                **DATE OF EVALUATION**

                                    
  --------------------------------- -------------------------------------

  -------- -------------------------------------------------------------------
  1\.      Please describe any impacts or benefits that you feel have resulted
           from the mediation process. Examples include repaired working
           relationships, enhanced communication or office productivity, cost
           savings and any other benefit you can identify.

           

  2\.      Are you satisfied with the overall process?

           

  3\.      Will your agency continue to use mediation?

           

  4\.      Is there anything that you think should be done to improve the
           Shared Neutrals Program?

           

  **5.**   If your agency has participated in a co-mediation, was it
           beneficial to have two mediators?

           

  **6.**   Please provide any other comments on the program.

           
  -------- -------------------------------------------------------------------

Thank you for taking the time to fill out this survey. The information
you have provided will help us to improve the program. Please mail the
questionnaire to:

Federal Executive Board of Minnesota

Room 510 Bishop Henry Whipple Federal Building

1 Federal Drive

Fort Snelling, Minnesota 55111-4058

Fax Number: (612) 713-7203

  ---------------------------------------------------- ------ ------ ---- ------------ -------------
  ![](media/image1.wmf){width="0.6972222222222222in"                                   FORM J
  height="0.6756944444444445in"}                                                       

  ---------------------------------------------------- ------ ------ ---- ------------ -------------

> Federal Executive Board of Minnesota - Shared Neutrals Program

# Mediator Application

  -- ---------------- ----------- --------------- ------------ ------------------------ --------------- ----------------- ---------- -------------- -- ----------- ----------- -- -- -- ----- ----- -----
                                                                                                                                                                                                    

     **NAME (Last,                                             **TITLE**                                                                                                                            
     First, MI)**                                                                                                                                                                                   

                                                                                                                                                                                                    

                                                                                                                                                                                                    

     **EMPLOYING                                               **COMPONENT/DIVISION**                                                                                                               
     AGENCY**                                                                                                                                                                                       

                                                                                                                                                                                                    

                                                                                                                                                                                                    

     **OFFICE                                                  **TELEPHONE NUMBER**                                       **FAX                                                                     
     ADDRESS**                                                                                                            NUMBER**                                                                  

                                                                                                                                                                                                    

                                                                                                                                                                                                    

                                                               **EMAIL ADDRESS**                                                                                                                    

                                                                                                                                                                                                    

     **SUPERVISOR'S                                                                                                                                                                                 
     NAME, TITLE AND                                                                                                                                                                                
     TELEPHONE**                                                                                                                                                                                    

                                                                                                                                                                                                    

     **Dispute                                                 List course title and                                                                                                                
     Resolution                                                name of agency                                                                                                                       
     Training**                                                sponsoring training.                                                                                                                 
                                                               Include dates, location                                                                                                              
                                                               and total hours of                                                                                                                   
                                                               actual instruction.                                                                                                                  
                                                               Include proof of                                                                                                                     
                                                               completion for all                                                                                                                   
                                                               training.                                                                                                                            

     **DATES**                                                                                                                                                                                      

     **START**        **END**     **COURSE                                                                                           **LOCATION**                  **HOURS**                        
                                  TITLE -                                                                                                                                                           
                                  SPONSORING                                                                                                                                                        
                                  AGENCY**                                                                                                                                                          

                                                                                                                                                                                                    

                                                                                                                                                                                                    

                                                                                                                                                                                                    

                                                                                                                                                                                                    

     **Attach                                                                                                                                                                                       
     additional                                                                                                                                                                                     
     sheets if                                                                                                                                                                                      
     necessary.**                                                                                                                                                                                   

     **Dispute                                                 Types of process, number                                                                                                             
     Resolution                                                of cases, co-mediation                                                                                                               
     Experience**                                              or individual sessions,                                                                                                              
                                                               evaluator(s) and years,                                                                                                              
                                                               co-mediations or                                                                                                                     
                                                               individual,                                                                                                                          
                                                               evaluations - who                                                                                                                    
                                                               conducted them                                                                                                                       

     **PROCESS**      **CASES**   **MEDIATOR OR                                                         **EVALUATIONS**                                **YEARS**                                    
                                  CO-MEDIATOR**                                                                                                                                                     

                                                                                                                                                                                                    

                                                                                                                                                                                                    

                                                                                                                                                                                                    

                                                                                                                                                                                                    

                                                                                                                                                                                                    

                                                                                                                                                                                                    

     **Attach                                                                                                                                                                                       
     additional                                                                                                                                                                                     
     sheets if                                                                                                                                                                                      
     necessary.**                                                                                                                                                                                   

     **Related                                                                          Work experience                                                                                             
     Experience**                                                                       as mediator,                                                                                                
                                                                                        attorney,                                                                                                   
                                                                                        investigator,                                                                                               
                                                                                        EEO Specialist,                                                                                             
                                                                                        etc. Attorneys                                                                                              
                                                                                        should indicate                                                                                             
                                                                                        subject matter                                                                                              
                                                                                        areas of                                                                                                    
                                                                                        substantive                                                                                                 
                                                                                        legal                                                                                                       
                                                                                        expertise.                                                                                                  

     **POSITION**                 **EMPLOYER**                                                          **PROCESS**                                    **YEARS**                                    

                                                                                                                                                                                                    

                                                                                                                                                                                                    

                                                                                                                                                                                                    

                                                                                                                                                                                                    

                                                                                                                                                                                                    
  -- ---------------- ----------- --------------- ------------ ------------------------ --------------- ----------------- ---------- -------------- -- ----------- ----------- -- -- -- ----- ----- -----

**Attach additional sheets if necessary.**

  --- -------------------------------------------------------------------
      **Any additional skills that would aid you in a
      mediation/facilitated process (e.g., foreign language fluency, sign
      language, etc.)**

      

      **Professional affiliations which you consider relevant to your
      activity as a neutral**

      
  --- -------------------------------------------------------------------

**MN-FEB FORM J: Mediator Application**

Page 2

# 

# 

# **Conduct Standards for Mediators in the Shared Neutrals Program**

The conduct of mediators in this program will be governed by the
following standards:

**Self-Determination:** Self-determination is the fundamental principle
of mediation. It requires that the mediation process rely upon the
ability of the parties to reach a voluntary, uncoerced agreement. Any
party may withdraw from mediation an any time.

**Impartiality:** A mediator shall mediate only those matters in which
she/he can remain impartial and evenhanded. If at any time the mediator
is unable to conduct the process in an impartial manner, he/she is
obligated to withdraw

**Conflicts of Interest:** A conflict of interest is any action or
relationship that might create an impression of possible bias. The basic
approach to questions of conflict of interest is consistent with the
concept of self-determination. The mediator has a responsibility to
disclose all actual and potential conflicts that are reasonably known
and could reasonably be seen as raising a question about impartiality.

**Competence:** A mediator will mediate only when he/she has the
necessary qualifications to satisfy the reasonable expectations of the
parties.

**Confidentiality:** A mediator will maintain the reasonable
expectations of the parties with regard to confidentiality.

**Quality of the Process:** A mediator shall conduct the mediation
fairly, diligently, and in a manner consistent with the principle of
self-determination.

# **Read and Sign the Following Statement**

I hereby certify that the information provided in this form or attached
is true to the best of my knowledge and belief and accurately reflects
my qualifications to provide dispute resolution services in cases
referred through the Federal Executive Board of Minnesota's Shared
Neutrals Program. I understand that all information herein is subject to
verification. I agree to keep my supervisor apprised of my dispute
resolution work and to ensure that this project will not interfere with
my daily work responsibilities. Furthermore, I hereby agree that if any
problem arises related to my involvement as a neutral or any
representations I have made related to this program, it shall be
resolved by the Shared Neutrals Council whose determination shall be
final on all matters. I have read the Standards of Conduct for Mediators
above and agree to abide by all such standards when acting as a neutral
under this program.

  ------------------------------ ------ ---------------------------------
                                        

  Signature of Applicant                Date
  ------------------------------ ------ ---------------------------------

# **Statement of Applicant's Supervisor**

I have reviewed the information on this form and believe it to be
accurate. Additionally, I approve of this applicant's participation in
the Shared Neutrals Program.

  ------------------------------ ------ ---------------------------------
                                        

  Signature of Applicant's              Date
  Supervisor                            
  ------------------------------ ------ ---------------------------------

  --- ----------------------------------------------------- ----------------------------------------------------------------
      ![](media/image2.wmf){width="0.17083333333333334in"   **Note to applicant:** Forward one complete copy of this form to
      height="0.14375in"}                                   your agency Shared Neutrals Coordinator

  --- ----------------------------------------------------- ----------------------------------------------------------------

**Privacy Act Statement:** The collection of this information is
authorized by 5 U.S.C. 574. This information will be used to update your
mediator profile. As a routine use, this information may be disclosed to
a congressional office at your request; to OMB for review of private
relief legislation; to a labor organization as required by the NLRA or
FLRA; where pertinent in a legal proceeding to which the government is a
party; to an appropriate law enforcement agency for investigative or
prosecutorial purposes; to a government agency where relevant to a
hiring, contracting, or licensing decision by the requesting agency; to
a government agency in order to elicit information relevant to a hiring,
contracting, or licensing decision by the government; to an expert or
consultant under contract with the government to fulfill an agency
function; to the Federal Records Center for storage; to the Equal
Employment Opportunity Commission for investigating a formal EEO
complaint filed under 29 C.F.R. 1614; to the Merit Systems Protection
Board or Office of Special Counsel for proceedings involving possible
prohibited personnel practices. The completion of this form is
voluntary; however, if this information is not provided, you may not be
included on the Federal Executive Board of Minnesota Shared Neutrals
Program roster of mediators.

  ---------------------------------------------------- ------ ------ ---- ------------ -------------
  ![](media/image1.wmf){width="0.6972222222222222in"                                   FORM J1
  height="0.6756944444444445in"}                                                       

  ---------------------------------------------------- ------ ------ ---- ------------ -------------

> Federal Executive Board of Minnesota - Shared Neutrals Program

# Mediator Continuing Education

<table style="width:100%;">
<colgroup>
<col style="width: 5%" />
<col style="width: 9%" />
<col style="width: 9%" />
<col style="width: 0%" />
<col style="width: 26%" />
<col style="width: 24%" />
<col style="width: 6%" />
<col style="width: 0%" />
<col style="width: 9%" />
<col style="width: 8%" />
</colgroup>
<tbody>
<tr class="odd">
<td></td>
<td colspan="4"><strong>NAME (Last, First, MI)</strong></td>
<td colspan="5"><strong>TITLE</strong></td>
</tr>
<tr class="even">
<td></td>
<td colspan="4"></td>
<td colspan="5"></td>
</tr>
<tr class="odd">
<td></td>
<td colspan="4"></td>
<td colspan="5"></td>
</tr>
<tr class="even">
<td></td>
<td colspan="4"><strong>EMPLOYING AGENCY</strong></td>
<td colspan="5"><strong>COMPONENT/DIVISION</strong></td>
</tr>
<tr class="odd">
<td></td>
<td colspan="4"></td>
<td colspan="5"></td>
</tr>
<tr class="even">
<td></td>
<td colspan="4"></td>
<td colspan="5"></td>
</tr>
<tr class="odd">
<td></td>
<td colspan="4"><strong>OFFICE ADDRESS</strong></td>
<td colspan="3"><strong>TELEPHONE NUMBER</strong></td>
<td colspan="2"><strong>FAX NUMBER</strong></td>
</tr>
<tr class="even">
<td></td>
<td colspan="3"></td>
<td></td>
<td colspan="3"></td>
<td colspan="2"></td>
</tr>
<tr class="odd">
<td></td>
<td colspan="4"></td>
<td colspan="3"></td>
<td colspan="2"></td>
</tr>
<tr class="even">
<td></td>
<td colspan="4"></td>
<td colspan="3"><strong>EMAIL ADDRESS</strong></td>
<td colspan="2"></td>
</tr>
<tr class="odd">
<td></td>
<td colspan="4"></td>
<td colspan="5"></td>
</tr>
<tr class="even">
<td></td>
<td colspan="9"></td>
</tr>
<tr class="odd">
<td></td>
<td colspan="4"><p><strong>Mediator Continuing</strong></p>
<p><strong>Professional Education</strong></p></td>
<td colspan="5">List course title and name of the agency sponsoring the
training. Include the dates, location and total hours of actual
instruction. Include proof of completion for any continuing education
completed other than events sponsored by the FEB Shared Neutrals
Council.</td>
</tr>
<tr class="even">
<td></td>
<td colspan="2"><strong>DATES</strong></td>
<td colspan="2"></td>
<td></td>
<td></td>
<td colspan="2"></td>
<td></td>
</tr>
<tr class="odd">
<td></td>
<td><strong>START</strong></td>
<td><strong>END</strong></td>
<td colspan="3"><strong>COURSE TITLE - SPONSORING AGENCY</strong></td>
<td colspan="3"><strong>LOCATION</strong></td>
<td><strong>HOURS</strong></td>
</tr>
<tr class="even">
<td></td>
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</tbody>
</table>

**Read and Sign the Following Statement**

I hereby certify that the information provided in this form or attached
is true to the best of my knowledge and belief and accurately reflects
continuing professional education completed by me.

I understand that all information herein is subject to verification.

  ------------------------------ ------ ---------------------------------
                                        

  Signature of Mediator                 Date
  ------------------------------ ------ ---------------------------------

  --- ----------------------------------------------------- ----------------------------------------------------------------
      ![](media/image2.wmf){width="0.17083333333333334in"   **Note to mediator:** Return completed form to the FEB Shared
      height="0.14375in"}                                   Neutrals Council no later than December 31, 2001. Forward one
                                                            complete copy of this form to your agency Shared Neutrals
                                                            Coordinator

  --- ----------------------------------------------------- ----------------------------------------------------------------

**Privacy Act Statement:** The collection of this information is
authorized by 5 U.S.C. 574. This information will be used to update your
mediator profile. As a routine use, this information may be disclosed to
a congressional office at your request; to OMB for review of private
relief legislation; to a labor organization as required by the NLRA or
FLRA; where pertinent in a legal proceeding to which the government is a
party; to an appropriate law enforcement agency for investigative or
prosecutorial purposes; to a government agency where relevant to a
hiring, contracting, or licensing decision by the requesting agency; to
a government agency in order to elicit information relevant to a hiring,
contracting, or licensing decision by the government; to an expert or
consultant under contract with the government to fulfill an agency
function; to the Federal Records Center for storage; to the Equal
Employment Opportunity Commission for investigating a formal EEO
complaint filed under 29 C.F.R. 1614; to the Merit Systems Protection
Board or Office of Special Counsel for proceedings involving possible
prohibited personnel practices. The completion of this form is
voluntary; however, if this information is not provided, you may not be
included on the Federal Executive Board of Minnesota Shared Neutrals
Program roster of mediators.

  ---------------------------------------------------- ------ ------ ---- ------------ -------------
  ![](media/image1.wmf){width="0.6972222222222222in"                                   FORM K
  height="0.6756944444444445in"}                                                       

  ---------------------------------------------------- ------ ------ ---- ------------ -------------

> Federal Executive Board of Minnesota - Shared Neutrals Program

# Mediator Trainee Evaluation

Please complete this evaluation form and return it to the FEB Shared
Neutrals Council. Thank you.

  ----------------------------------- -----------------------------------
  **MEDIATOR**                        **AGENCY**

                                      

  **MEDIATOR TRAINEE**                **TRAINEE'S AGENCY**

                                      

  **CASE NUMBER**                     **MEDIATION DATE\[S\]**

                                      
  ----------------------------------- -----------------------------------

Please evaluate the Mediator-Trainee using the following scale. Remember
that an honest critique is needed so that skills can be developed. You
are directed to share all comments with the trainee in a positive light
including alternatives that may be more efficient.

  --------------- ----------- ---------- -- -- -------- -------- -- -- ---- --------------- -- -- -- --------------
                                                                                                     

  **1**                       **2**                     **3**               **4**                    **5**

  **Needs                     **Good**                  **Very              **Excellent**            **Not
  Improvement**                                         Good**                                       Observed**
  --------------- ----------- ---------- -- -- -------- -------- -- -- ---- --------------- -- -- -- --------------

  ----------- ------------------------------------------------- ---- --- --- --- ---
                                                                1    2   3   4   5

  1           Providing introduction                                             

  2           Listening                                                          

  3           Empathizing                                                        

  4           Maintaining confidentiality                                        

  5           Assisting parties in creating options                              

  6           Testing perceptions against facts                                  

  7           Caucusing                                                          

  8           Reaching closure/agreement                                         

  9           Allowing parties to own the process                                

  10          The mediator-trainee was fair                                      

  11          The mediator-trainee was effective                                 

                                                                                 

  Was there                                                                      
  any                                                                            
  critical                                                                       
  element of                                                                     
  the                                                                            
  mediation                                                                      
  process                                                                        
  that the                                                                       
  trainee had                                                                    
  problems                                                                       
  with? If                                                                       
  so, please                                                                     
  explain:                                                                       

                                                                                 

                                                                                 

                                                                                 

                                                                                 

                                                                                 
  ----------- ------------------------------------------------- ---- --- --- --- ---

Thank you for taking the time to fill out this survey. The information
you have provided will help us to improve the program. Please mail the
questionnaire to:

Federal Executive Board of Minnesota

Room 510 Bishop Henry Whipple Federal Building

1 Federal Drive

Fort Snelling, Minnesota 55111-4058

Fax Number: **(612) 713-7203**