Mediation Report Form
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1APPENDIX G (L.R. 7.05)
IN THE COMMON PLEAS COURT
BUTLER COUNTY, OHIO
MEDIATION REPORT FORM
Case No:
Case Caption:
Parties Present: (Include attorneys, clients and insurance adjustors)
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Result/Status:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Comments:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
_____________________________
MEDIATOR SIGNATURE
Please return completed report to the Court Administration office. DO NOT FILE.
Appendix
Page 9
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