Mediator Report Form

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MEDIATOR REPORT FORM
Party's Name:
Counsel for Party:
Party's Name:
Counsel for Party:
Party's Name:
Counsel for Party:
Date of Mediation:
Time Mediation Session Begins:
Time Mediation Session Ends:
Time Taken For Breaks, including lunch
Issues Resolved:
Is the entire matter resolved between the parties?
Yes
No
If not, describe the remaining dispute:
Yes
No
Is further mediation scheduled?
If so, what is the date and time of the second session?
(Signed)
(Print Name)
(Date)
Click here to print this form
ECBA File #

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