Mediation Agreement
This is an agreement by ____________________ and _____________________
(Name of party involved) (Name of party involved)
to voluntarily enter into the confidential process of mediation. The parties have agreed the mediator for this process will be ______________________. The mediator’s role is to facilitate dialogue between the parties. The mediator will be unbiased and will not advise, influence or make decisions for the parties about how the matter is to be resolved. In no event will the mediator disclose confidential information provided during the course of this meditation. Nor will they testify voluntarily on behalf of either party, or submit any report or agreement (except those agreed upon in this contract) made by the parties to any authority—including court—in connection with this mediation now or in the future. Except, where the information suggests, there will be actual or potential threat to human life or safety.
The parties agree that all statements made and information revealed by them, during the course of the mediation are strictly confidential, without prejudice and not admissible for purposes of legal proceedings, or any other process the disputants may enter into in the future. The parties agree that no attempt will be made to call the mediator to testimony or grievance. The parties have full, unqualified authority to settle the controversy. The parties agree to proceed in good faith.
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The parties may withdraw from the process at any time—should this occur, the parties agree to meet separately/privately (caucus) with the mediator before terminating the process. The mediator may also terminate the process at their discretion.
A copy of the “Agreement to Mediate” and a copy of the “Settlement Agreement” will be provided to the parties, (and if required), to the employer or employer’s representative. CONSENT TO THIS AGREEMENT: Each of us has read this agreement and agrees to proceed with the mediation on the terms contained herein.
Signature/date:_________________________ Signature/date:__________________________ Mediator/date:_________________________
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