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Alternative Dispute Resolution (ADR)

 

Attachment A

 

VISN MEDIATION PROGRAM SAMPLE
DRAFT ATTACHMENT A

Department of Veterans Affairs
VISN X Mediation Program
INSTRUCTIONS
Request/Consent For Mediation

The following Request/Consent for Mediation form should be submitted to the labor management specialist or appropriate management official designated responsible for coordinating such requests, who will take appropriate steps to immediately contact the other party(s) regarding its (their) willingness to participate in mediation.

In the event the opposing parties jointly request mediation, the signed form should be forwarded to the labor management specialist or appropriate management official designated responsible for coordinating such requests.

The labor management specialist or appropriate management official designated responsible for coordinating such requests shall inform both parties regarding the status of the request for mediation.

If either party has any questions regarding the mediation process they may contact, at ___________________ at _____________________.

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