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NASA Procedural Requirements |
NPR 3713.2B Effective Date: May 22, 2017 Expiration Date: December 01, 2024 |
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This Appendix includes templates related to ADR and settlement agreements which are recommended for use at all NASA Centers. Centers may customize the templates to meet their needs. For example, the settlement agreement template is usually customized for each individual case to address the unique settlement terms of that case. The templates include:
C.1 ADR Election Form (Formal Stage)
C.2 ADR Election Form (Informal)
C.3 Agreement to Mediate
C.4 ADR Participant Evaluation
C.5 Mediator's Evaluation
C.6 Reporting on Compliance with EEO Settlement Agreement
C.7 Settlement Agreement Compliance Checklist
National Aeronautics and Space Administration
Equal Employment Opportunity
Alternative Dispute Resolution
EEO ADR ELECTION FORM
In accordance with 29 C.F.R. § 1614, the National Aeronautics and Space Administration (NASA) offers you the opportunity to utilize NASA's Equal Employment Opportunity (EEO) Alternative Dispute Resolution (ADR). Please indicate your decision below and return to NASA's EEO ADR Program Manager by (DATE):
________ I will utilize NASA's EEO ADR Process. I understand with this election, the formal complaint processing of my EEO complaint is extended for another 90 days.
________ I do not wish to utilize EEO ADR but instead chose to continue with the formal processing of my EEO complaint. (Please provide reason/s why you decided not to participate in ADR to assist ODEO in evaluating the effectiveness of the Agency EEO ADR Program and determining ways to improve and increase ADR utilization.)
________ I have no interest in pursuing this matter in either process and hereby withdraw my EEO complaint.
___________________________________ | ____ |
Name | Date |
National Aeronautics and Space Administration Equal Employment Opportunity Alternative Dispute Resolution
EEO ADR ELECTION FORM
In accordance with 29 C.F.R. § 1614, the National Aeronautics and Space Administration (NASA) offers you the opportunity to utilize NASA's Equal Employment Opportunity (EEO) Alternative Dispute Resolution (ADR). Please indicate your decision below and return to the Center's EEO ADR Program Manager by (DATE):
________ I will utilize NASA's EEO ADR Process. I understand with this election, the informal complaint processing of my EEO complaint is extended for another 60 days (90 total days).
________ I do not wish to utilize EEO ADR but instead chose to continue with the informal processing of my EEO complaint. (Please provide reason/s why you decided not to participate in ADR to assist ODEO in evaluating the effectiveness of the Center EEO ADR Program and determining ways to improve and increase ADR utilization.)
________ I have no interest in pursuing this matter in either process and hereby withdraw my EEO complaint.
___________________________________ | ____ |
Name | Date |
AGREEMENT TO MEDIATE
This agreement concerns the EEO Complaint of _______________________, NASA Docket No. ____________________. The parties signing below agree to engage in mediation in good faith to explore issues and options in an attempt to resolve matters in dispute. The parties agree to the following:
Mediation is voluntary and may be ended at any time by any party or the mediator(s).
The parties understand that the mediator(s) will not: decide anything; give legal or other professional advice; act as advocates for any party; or promote any particular outcome. The role of the mediator(s) is to listen; help the parties clarify their issues, interests, and concerns; and generally facilitate the parties' negotiations.
The parties understand that mediation is a confidential process, except as specifically provided in or waived in writing under applicable laws, and matters disclosed in mediation cannot be used as evidence in any subsequent administrative or judicial proceeding (except as such matters may be otherwise discoverable). The parties specifically agree that such confidentiality extends to their joint meetings as well as their private meetings with the mediator(s). In addition, until reduced in writing and signed by all parties, all terms of any offers, options, and agreements made in connection with the mediation are deemed nonbinding proposals and are confidential. A written agreement reached through mediation and signed by all parties will not be confidential, unless the parties specifically agree otherwise in writing. Confidentiality is not available and is waived by everyone signing below as to: threats of imminent harm or incidents of violence occurring during mediation, criminal acts or plans to commit criminal acts, and fraud.
The mediator(s) will not voluntarily testify on behalf of any party. The parties agree not to subpoena the mediator(s) or the mediator(s) records. The parties understand that the mediator(s) destroy their notes after the mediation and that any documents submitted to the mediator(s) by any party are returned to the submitting party or destroyed. The parties agree that the mediator(s) will not be held liable for any claim arising from the mediation process. Where required by the court or administrative body referring the dispute to mediation, the mediator(s) may submit a report to that court or administrative body, but the report will contain only information as to: whether the parties attended mediation, whether mediation has ended, and whether an agreement resolving the dispute was reached or not.
If a settlement is reached, the agreement shall be reduced to writing and when signed shall be binding upon the parties. If a settlement is not reached, the matter in dispute will proceed as if mediation had not occurred.
Since the parties are negotiating concerning matters that affect their legal rights, the parties have the right and opportunity to consult with legal counsel at any time and are encouraged to do so.
_________________________ | _____________________ | |
_________________________ | _____________________ | |
[Signature/date lines for all persons attending the mediation.] |
(Copies of the following evaluation template shall be distributed to each person who attended as a party or representative in mediation, along with an envelope in which to return the evaluation form. The mediator will gather the sealed envelopes and submit them to the ADR Program Director. Generally, the parties are requested to complete the survey when mediation ends but before they leave the mediation site; however, a party who wishes to submit the template later may do so (provide an envelope addressed to the ADR Program Director).
MEDIATION PARTICIPANT SURVEY
To help NASA to continue to improve its ADR program and provide outstanding customer service, we would appreciate your taking a few minutes to answer the following questions. There is room at the end for comments, if you like. The information below is confidential and will be used solely for program evaluation purposes. It is not necessary to include your name unless you wish to do so.
In this mediation, I was the:
( ) Aggrieved Complainant
( ) Management Representative
( ) A Representative
( ) Other
Center where mediation occurred: ____________________________
At which phase of the process is this mediation occurring?
( ) Pre-Counseling Stage
( ) Formal Complaint Stage
The Process
1a. Prior to the mediation, the opportunity for mediation was:
( ) Fully explained to me
( ) Adequately explained to me
( ) Poorly explained to me
( ) Not explained to me
1b. Prior to the mediation, the mediation process was:
( ) Fully explained to me
( ) Adequately explained to me
( ) Poorly explained to me
( ) Not explained to me
2. The mediation was scheduled within:
( ) 5-15 days of the initial complaint
( ) 16-25 days of the initial complaint
( ) 26-35 days of the initial complaint
( ) 36 or more days of the initial complaint
3. The mediator explained the mediation process to me in a way that
allowed me to fully understand the process.
( ) Strongly Agree
( ) Agree
( ) Disagree
( ) Strongly Disagree
4. I had a full opportunity to present my views.
( ) Strongly Agree
( ) Agree
( ) Disagree
( ) Strongly Disagree
5. If I had another dispute or problem like this one, I would want to try mediation to resolve it.
( ) Strongly Agree
( ) Agree
( ) Disagree
( ) Strongly Disagree
6. I would recommend mediation to others at the Center.
( ) Strongly Agree
( ) Agree
( ) Disagree
( ) Strongly Disagree
If you disagree, please provide more information.
The Mediator
Name(s) of mediator(s): ____________________________________________
7a. The mediator listened well.
( ) Strongly Agree
( ) Agree
( ) Disagree
( ) Strongly Disagree
7b. The mediator treated everyone fairly.
( ) Strongly Agree
( ) Agree
( ) Disagree
( ) Strongly Disagree
8. The mediator remained neutral and impartial.
( ) Strongly Agree
( ) Agree
( ) Disagree
( ) Strongly Disagree
9. The mediator worked with both sides to help reach a fair resolution.
( ) Strongly Agree
( ) Agree
( ) Disagree
( ) Strongly Disagree
10. I was treated with respect during the mediation.
( ) Strongly Agree
( ) Agree
( ) Disagree
( ) Strongly Disagree
The Result
11. Please circle the appropriate answer:
a. Mediation is completed and we reached a resolution.
b. Mediation is still open or continued.
c. Mediation is completed, but we did not reach a resolution.
12. If you reached agreement, do you believe it is as fair and realistic as reasonably possible?
( ) Yes
( ) No
If no, why not? _______________________________________________
13. If no agreement was reached, do you believe the mediation was still helpful?
( ) Very Helpful
( ) Somewhat Helpful
( ) Slightly Helpful
( ) Not Helpful
14. Do you have any comments that might help us improve this program?
________________________________________________________
Name and contact information (voluntary):
_________________________________________________________
Thank you for taking your time to assist us in trying to continually improve our program.
For the case you just completed, please answer the following questions (explain your answers if needed in the space under each question):
a. After you were assigned this case, were you promptly given adequate information by intake personnel on:
- Nature of case and issues? __ yes __ no
- Parties' and representatives' contact info? __ yes __ no
- Any special needs or issues? __yes __no
Comments:
b. Did you find intake personnel prompt and helpful regarding:
- Arranging place/space for mediation? __yes ___ no
- Providing forms, copying, and administrative help? __yes __ no
- Providing help/suggestions for travel and accommodations? __yes __no
Comments:
c. Did you find that the parties adequately understood their ADR options and had at least a preliminary understanding of what ADR was about? __yes __ no
Comments:
d. Please provide any other comments and suggestions for improvement in the ADR program:
e. Name and contact information.
THANK YOU!
OFFICE OF DIVERSITY AND EQUAL OPPORTUNITY
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This document does not bind the public, except as authorized by law or as incorporated into a contract. This document is uncontrolled when printed. Check the NASA Online Directives Information System (NODIS) Library to verify that this is the correct version before use: https://nodis3.gsfc.nasa.gov.