Okla. Stat. tit. 12, app D

Current through Laws 2024, c. 453.

Appendix D - Record of Termination

_______________________________________ Initiating Party	Case No. _____________
_______________________________________ Responding Party	Date _________________
Starting Time ___________	Ending Time ___________

If a mediation session was not held, indicate whose absence was responsible: (a.) Initiating party, (b.) responding party, or (c.) both parties. _________

If a mediation session was held, please complete the remainder of this record.

1. Nature of Dispute (briefly describe)

____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________

2. Relationship of Parties (briefly describe) ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________

3. Persons, other than the parties, present at mediation (name, address, telephone, relationship)

____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________

4. Indicate at what stage the mediation session terminated:

____ Introduction

____ Information exchange Negotiations

____ Agreement

5. Comments

____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________

6. If there is a referral to another agency, indicate which party was referred and to what agency

____________________________________________________________________________________________ ____________________________________________________________________________________________

7. Describe follow-up plan

____________________________________________________________________________________________ ____________________________________________________________________________________________

8. Recommendations and Remarks

____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________

______________________________________ Mediator

Okla. Stat. tit. 12, app D

Adopted 4/8/1986; Revised 4/20/1989.