FDR Mediation Outcomes Mediator:* First Last Mediator's Email* Enter Email Confirm Email FDR Centre Case Number and Name:* Did the parties engage in PFM or Voice of the Child?* PFM Voice of the Child None of the above Preparation for MediationHow many hours of PFM services were provided to the parties?*Please provide this to the closest 15 minutes. : Hours Minutes Voice of the ChildHow many hours of Voice of the Child services were provided to the parties?*Please provide this to the closest 15 minutes. : Hours Minutes Agreement to Mediate and Confidentiality Agreement file uploadIf you haven't already provided a copy of the FDR Centre Agreement to Mediate or Confidentiality Agreement (if applicable), please upload signed copies here. Drop files here or Select files Max. file size: 256 MB. MediationMediation dates:If Mediation was provided on multiple days, please enter all the dates here (Important Note -If you have already submitted a Mediation in Progress outcome form for prior mediations do not record them here)1. Date* DD slash MM slash YYYY Time of Mediation*Time of the first session (in 24hr format) : Hours Minutes Hours claimed for this session*Please enter a number from 0 to 12.There are no restrictions as to the length of mediation event as long as it is appropriate for dispute. How was the Mediation undertaken?* In person Telephone/videoconference Location of in-person mediation*Please provide the name of the city/town in which in-person mediation was conducted Are you recording multiple mediation dates?NoYes2. Date: DD slash MM slash YYYY Time of MediationTime of the first session (in 24hr format) : Hours Minutes Hours claimed for this sessionPlease enter a number from 0 to 12.How was the Mediation undertaken? In person Telephone/videoconference Location of in-person mediationPlease provide the name of the city/town in which in-person mediation was conducted 3. Date: DD slash MM slash YYYY Time of MediationTime of the first session (in 24hr format) : Hours Minutes Hours claimed for this sessionPlease enter a number from 0 to 12.How was the Mediation undertaken? In person Telephone/videoconference Location of in-person mediationPlease provide the name of the city/town in which in-person mediation was conducted 4. Date: DD slash MM slash YYYY Time of MediationTime of the first session (in 24hr format) : Hours Minutes Hours claimed for this sessionPlease enter a number from 0 to 12.How was the Mediation undertaken? In person Telephone/videoconference Location of in-person mediationPlease provide the name of the city/town in which in-person mediation was conducted Outcome Decision*Please note that the questions below replicate the form that your case manager will be required complete in RMS to issue the S12 certificate. Joint withdrawal by all parties FDR Completed - no matters resolved FDR Completed - some matters resolved FDR Completed - all matters resolved FDR Exempt Mediation in progress Please note that the expectation of the MoJ is that at least 80% of the matters that reach mediation result in "Some or all matters resolved". Please advise your manager if the complexity of the cases are changing the trend. Briefly list matters still in dispute below.*This will be entered in the Section 12 form. RMS form allows up to 400 characters only (ie about 4 lines in Arial 10pt)Briefly list matters which were agreed on below.*This will be entered in the Section 12 form. This field in RMS has a character limit of 400, ie about 4 lines in Arial 10pt)Do you recommend the parties attend a settlement conference?* Yes No Do you recommend the parties receive legal representation?* Yes No Why was the case FDR exempt?*Select oneInappropriate to continue with FDRParty at riskParty did not participateUnable to participate effectivelyWho should the exemption be issued to?*Name(s) of those to whom the exemption is to be issued. Please note: In principle, an outcome indicating "inappropriate to continue with FDR" may suggest that the parties should not be able to resume mediation during the same FDR cycle. However, if circumstances change, and the parties want to return to mediation, your case manager will first check with you whether you consider that the case is now appropriate to resume mediation. Reason for exemptionPlease include a brief description of the reasons that your case manager can share with the parties where needed. This will not be included in the S12 certificate. TravelDo you wish to claim travel for the Mediation?*Only answer "yes" if you wish to claim your travel time as a disbursement. Please note that you can only claim the travel time from your work address to the location of the mediation where the travel distance is over 50km. Please note the Ministry of Justice’s prior approval is required for any travel expenses and room hire which will in total exceed $500 (including GST) per event. Yes No How many hours travel time are you claiming?*To the nearest 15 minutes. : Hours Minutes How many kilometres did you travel?* Work Address* Street Address Address Line 2 City Address of Mediation* Street Address Address Line 2 City If you are claiming travel time as a disbursement for multiple days and/or locations, please explain below.Please ensure you include the travel cost as a disbursement in your invoice.Room HireageDo you wish to claim room hireage as a disbursement?*Room hireage can be claimed up to a maximum of $230 (including GST) per day pro-rated, ie if room is required for a half-day, funding will be limited to $115 (including GST). Yes No Please indicate the amount you are claiming for room hireage excluding GST Please ensure you include the room hireage charge as a disbursement in your invoice.Invoice and payment for FDR MediationFor payment of your fee for Mediation services, please provide us with a tax invoice by uploading it below. Your invoice should be based on an hourly rate of $160.00 including GST.If you wish to claim travel or room hireage as a disbursement, please ensure this is included in your invoice as well. Drop files here or Select files Max. file size: 256 MB. Parenting Agreement UploadIf applicable, please upload signed parenting agreement hereOften participants reach out to our case managers for a copy of their parental agreement. We are able to keep a copy in file whenever it is available. Drop files here or Select files Max. file size: 256 MB. Final CommentsIs there anything further that your case manager should know at this time?
