forms for Court-ordered mediation

Forms for Mediators to File and Serve

    1. Submit the Mediator’s Notice of Acceptance or Recusal to formally notify the court and parties that you have accepted or recused or to report that the mediation will not be scheduled. Submit this form within 15 days after notice of party stipulation or court assignment. If you accept, calendar the Mediation Completion date right away.

    2. Submit the Judicial Council Statement of Agreement or Non Agreement to formally notify the court and parties of the case status. CRC Rule 3.895 . Submit this form within 10 days after the Mediation Completion Date even if there was no mediation. This form notifies court staff to move the case to the next step, Trial Setting Conference; OSC re Dismissal; or OSC and Sanctions re Failure to Complete Mediation.  

Forms to Submit to ADR Director

Submit the Mediator’s Fee Statement to bill the court $150 for the  mediation.

Submit the Mediator’s Record of Service to keep track of your mediations and to provide feedback to the ADR Director.

Forms to Give Parties/Counsel

    1. Use the Judicial Council form Attendance Sheets to obtain the mediation  participants’ contact information. Keep these forms for two years. Do not submit these to the court unless requested to do so. CRC Rule 3.860

    2. Encourage parties/counsel to submit the Post-Mediation Survey. Local Rule 3228

    3. Continuances: There is no authority to schedule a mediation after the Mediation Completion Date ordered by the court. If parties need additional time, they must file the Stipulation and Order for Continuance of Court-Ordered Mediation. There is a $20 filing fee.

Optional Forms

To assist with your conflicts and disclosures checks (CRC Rule 3.855) you may wish to use the Disclosures Checklist.

To charge parties for additional time after the first 3 hours of mediation services, you may wish to use or adapt the Stipulation re Fee for Ongoing Services for Court-Ordered Mediation.

© 2011 Superior Court of California, County of Riverside