Attention A T users. To access the menus on this page please perform the following steps. 1. Please switch auto forms mode to off. 2. Hit enter to expand a main menu option (Health, Benefits, etc). 3. To enter and activate the submenu links, hit the down arrow. You will now be able to tab or arrow up or down through the submenu options to access/activate the submenu links.
Attention A T users. To access the combo box on this page please perform the following steps. 1. Press the alt key and then the down arrow. 2. Use the up and down arrows to navigate this combo box. 3. Press enter on the item you wish to view. This will take you to the page listed.
Menu
Menu
Veterans Crisis Line Badge
My healthevet badge

Alternative Dispute Resolution (ADR)

 

Attachment D

 

VISN MEDIATION PROGRAM SAMPLE
DRAFT ATTACHMENT D

Department of Veterans Affairs
VISN X Mediation Program
USER SATISFACTION SURVEY

To find ways to assess and improve the VISN X Mediation Program, persons who have participated in the Program are requested to complete this questionnaire. Your assistance is voluntary, but will help us with making the necessary improvements! Please return the questionnaire to the appropriate local management official designated to coordinating mediation requests, or mail to: VISN X Mediation Program Survey Results, Office of Regional Counsel Region 23 (318/02), 251 N. Main Street, Winston-Salem, NC 27155.

1. VA facility: _____________________________________________________

2. Name of matter: _________________________________________________

3. Type(s) of issues: ________________________________________________

4. Describe the type of settlement that resulted form the mediation process.

o Full settlement of all issues
o No settlement of any issues
o Partial settlement of the issues

5. Please describe any other impacts or benefits that you felt resulted from the mediation process. Examples might include relationships repaired, communication enhanced, office productivity enhanced, money saved, etc.
_____________________________________________________________________

_____________________________________________________________________

6. Were you satisfied with the process?

o Yes
o No

Please provide any comments _________________________________________
_____________________________________________________________________

7. Would you use mediation again?

o Yes
o No

Please provide any comments _________________________________________
_____________________________________________________________________

8. Is there anything that you think should be done to improve the VISN X mediation Program?

o Yes
o No

Please provide any comments ______________________________________________________________

______________________________________________________________________________________

9. Please rate the following items on a scale of 1 to 5 by circling the number that represents your choice:

1 = strongly disagree


2 = somewhat disagree


3 = neither agree or disagree


4 = somewhat agree


5 = strongly agree


N = don’t know or are unable to determine

a. The mediation process was impartial. 1 2 3 4 5 N


b. The right parties were at the table. 1 2 3 4 5 N

c. Both sides negotiated in good faith. 1 2 3 4 5 N

d. Mediation was appropriate for this matter. 1 2 3 4 5 N

e. You were able to fully present your case. 1 2 3 4 5 N

f. The mediator helped create a positive
atmosphere. 1 2 3 4 5 N

g. The mediator helped create realistic
options for settling the matter. 1 2 3 4 5 N

h. The mediator was impartial. 1 2 3 4 5 N

i. The mediator participated the right amount. 1 2 3 4 5 N

j. The mediator listened well. 1 2 3 4 5 N

i. The mediator helped clarify the
key issues of the parties. 1 2 3 4 5 N

k. The mediator explained the process well. 1 2 3 4 5 N

l. The mediator was fair. 1 2 3 4 5 N

m. The mediator was effective. 1 2 3 4 5 N

 

10. If this was a co-mediation, was it beneficial to have two mediators?

o Yes
o No

Please provide any comments ______________________________________________________________

______________________________________________________________________________________

11. Please provide any other comments: ______________________________________________________

______________________________________________________________________________________

Thank you for taking the time to complete this questionnaire. Please return it to the appropriate local management official designated to coordinating mediation requests, or mail to: VISN X Mediation Program Survey Results, Office of Regional Counsel ().