Mediation Teleconference Customer Survey


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In an effort to better serve our customers, the bureau is conducting a survey of those that have participated in mediation hearings by teleconference. We would appreciate you taking a few moments to answer the following questions.

Bold = required fields

1. Claimant Name:

2. Date of Mediation Teleconference:

3. I am a:

	Claims Examiner
	Attorney
	Other

4. My mediation teleconference hearing was handled by:

	Mediator Boucher
	Mediator Burden
	Mediator Cooper
	Mediator Miron
	Mediator Riley

5. During the mediation teleconference, the mediator:

a.	Clearly explained the mediation process	Yes	No
b.	Advised the parties of their rights and entitlements under the law	Yes	No
c.	Allowed each side an opportunity to present their side	Yes	No
d.	Demonstrated an understanding of the issue(s) invloved	Yes	No
e.	Recommended possible solutions in order to resolve the claim	Yes	No
f.	Was respectful and courteous to the participants	Yes	No
g.	Remained impartial and non-biased during the teleconference	Yes	No

6. How was the claim resolved after the mediation teleconference?

	Resolved or withdrawn
	Transferred to the magistrate for hearing

7. After participating in a mediation teleconference, I would prefer this method of handling a claim rather than an in-person conference at a bureau office.

	Strongly agree
	Agree
	No preference
	Disagree
	Strongly disagree

8. Comments:

FIRST NAME:		LAST NAME:
ORGANIZATION:
ADDRESS:
CITY, STATE, ZIP:
TELEPHONE NO.:
E-MAIL ADDRESS:

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