Mediation- 360 Degree Feedback Survey

About this Survey

Mediation is a structured process in which a neutral third party facilitates dialogue between disputing parties to help them reach a voluntary, mutually acceptable resolution. The mediator maintains control of the process by managing emotional dynamics, ensuring informed consent, and addressing obstructive behaviors while preserving confidentiality and trust. Through careful preparation, strategic planning, and active listening, the mediator gathers information, identifies core issues, and frames them in ways that promote clarity, empathy, and constructive negotiation. Flexibly guiding information exchange, private meetings, and decision-making, the mediator supports parties in exploring options, resolving disputes, and building durable agreements.

This questionnaire is designed to give HR leaders clear, actionable insight into the key drivers of Mediation Skills. Each item reflects well-constructed dimensions of mediation, allowing you to quickly identify strengths, gaps, and opportunities for improvement. The survey is fully customizable, enabling you to tailor questions to your culture, workforce, and strategic priorities without starting from scratch. HR‑Survey partners with you to refine the instrument, interpret results, and ensure you gather the data needed to make confident, evidence‑based decisions. By using this tool, you gain a reliable, efficient way to understand your employees' experience and strengthen engagement across your organization.

Important Aspects of Mediation

• Maintains Neutral Position: the mediator's ability to remain impartial, balanced, and non-directive throughout the mediation process. It involves consciously avoiding favoritism, ensuring both parties feel equally heard, and preserving their autonomy in decision-making. This includes balancing power dynamics, distributing attention evenly, and validating each party's perspective without endorsing their position. Neutrality is not passive--it requires active effort to create a fair environment where both sides trust the mediator's role as an unbiased facilitator.
• Maintains Control: the mediator's role in managing the structure, flow, and discipline of the mediation process. It includes setting boundaries, enforcing agreed-upon procedures, and intervening when behaviors become disruptive or counterproductive. Control ensures that the session remains focused, timely, and respectful, while also safeguarding informed consent and voluntary participation. Whereas neutrality governs the mediator's stance toward the parties, control governs the mediator's stewardship of the process itself.
• Facilitative: the mediator's overarching role in helping parties communicate effectively, uncover shared interests, and move toward voluntary, mutually acceptable outcomes. This dimension is about how the mediator supports dialogue -- by fostering understanding, reducing conflict, and enabling consensus-building. It's relational and process-oriented, focusing on the mediator's ability to create a collaborative environment where resolution becomes possible.
• Preparation and Planning: the foundational setup of the mediation. It includes logistical readiness (e.g., agenda creation, participant identification), emotional groundwork (e.g., assessing readiness, creating psychological safety), and procedural clarity (e.g., understanding confidentiality and legal considerations). This dimension ensures that the environment is respectful, inclusive, and well-structured before substantive dialogue begins. It's about getting the room and the people ready (emotionally, procedurally, and practically).
• Issue Identification: focuses on what the conflict is about -- identifying, organizing, and clarifying the specific concerns, interests, and misunderstandings that need to be addressed. This includes surfacing root causes, grouping related issues, and helping parties prioritize what matters most.
• Information Gathering: focuses on how the mediator collects, interprets, and synthesizes information to understand the dispute's structure, the parties' interests, and the emotional or relational dynamics at play. This includes asking open-ended questions, probing for deeper meaning, identifying gaps, and discerning between positions and underlying needs. The mediator is essentially building a mental map of the conflict -- not yet sharing, but absorbing, analyzing, and organizing.
• Maintains Confidentiality: the ethical and procedural handling of sensitive information. It involves setting clear expectations about what will remain private, honoring those commitments consistently, and using discretion when summarizing or sharing content from private conversations. This competency safeguards the integrity of the process by ensuring that parties feel safe to speak openly, knowing their disclosures won't be misused or revealed without consent. It's about protecting what is said and how it is handled behind the scenes.

The Questionnaire

Instructions:

[Company] is conducting a 360-Degree Feedback Assessment developed by HR-Survey for selected managers.

You have been selected to provide feedback on the employee listed above. Your feedback is an important part of our company's leadership development process and this survey is intended to gather broad feedback in the core competencies and role responsibilities that are important for the on-going success of our organization.

In responding to the questions below, think about your experiences working with this employee over the last twelve months. The effectiveness of this development tool is dependent on your honest, forthright and constructive responses so please bear this in mind as you answer each question. Your responses will be aggregated with the responses received from others and discussed with the employee to foster growth and on-going development.

Partially completed forms can be saved by using the Save/Still Working button at the bottom of the page. You may return at a later time to complete/edit the form. Your saved responses will be shown each time you re-visit the feedback form. When you are certain that you have completed your responses, and will be not making any changes, click the Complete button.

Your feedback is valuable in helping the individual to understand how they are perceived and experienced by others and the impact their behavior has on people in the organization with whom they interact. Feedback received also acknowledges strengths and identifies areas for development.

Use the form below to provide your feedback. Each field and comment box requires a response before you can SUBMIT your final feedback.

Thank you for your participation in the survey. We look forward to seeing the analysis of your responses and we are hoping for 100% participation.

Management Team

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Mediation

Role
Model

Capable and
Effective

Somewhat
Effective

Needs
Development

Maintains Neutral Position

1. Acts as a neutral person to provide intervention in the negotiation process.

2. Maintains neutrality while actively listening and validating each party's perspective.

3. Balances time and attention between parties to maintain perceived neutrality.

4. Ensures that both parties are able to retain their freedom to make their own decisions.

Maintains Control

5. Stays focused on the meeting and does not get distracted by side issues.

6. Deals with argumentative or obstructive behaviors from either party.

7. Maintains control of the facilitation session.

8. Reminds participants of the mediation rules and agreed procedures as needed.

Facilitative

9. Collaborates with both parties to obtain a viable solution.

10. Helps parties gain clarity and insight into the dispute by asking questions that reveal core concerns.

11. Helps parties move from impasse to resolution without litigation or coercion.

12. Facilitates reaching agreement between the two parties.

Preparation and Planning

13. Acknowledges emotional undercurrents without taking sides, helping parties feel heard and respected.

14. Creates a safe and respectful environment for open discussion.

15. Creates a checklist (or agenda) for the meeting to ensure all topics are discussed.

16. Determines the best approach to take for the mediation.

Determines Strategy

17. Conducts a conflict assessment and risk analysis to determine the best course of action.

18. Explores historical context and prior attempts at resolution to inform strategy.

19. Analyzes power dynamics, communication styles, and emotional tone to tailor the mediation approach.

20. Negotiates ground rules and confidentiality terms to support psychological safety and transparency.

Issue Identification

21. Explores underlying interests and motivations through thoughtful, open-ended questioning.

22. Identifies the relevant interests of each party.

23. Identifies procedural issues that may impact the mediation.

24. Clusters related issues to streamline negotiation and reduce redundancy.

Information Gathering

25. Evaluates the relevance and sensitivity of information before sharing it with other parties.

26. Determines if information should be shared or withheld.

27. Gathers information to understand people's interests and needs.

28. Clarifies ambiguous statements and probes for deeper meaning to ensure accurate understanding.

Directs Information Exchange

29. Determines what information should be shared with either party.

30. Poses respectful, curiosity-driven questions to help parties articulate concerns and clarify misunderstandings.

31. Filters out irrelevant or inflammatory content to keep the dialogue focused and productive.

32. Determines what documents are to be exchanged with each side.

Maintains Confidentiality

33. Fosters psychological safety by honoring confidentiality commitments without exception.

34. Refrains from using confidential information to influence or pressure either party.

35. Clearly communicates what will remain confidential and what may be shared with consent.

36. Demonstrates consistency in applying confidentiality standards across parties and sessions.

37. Overall, please rate the effectiveness of [Participant Name Here].
    

    5- Very Effective 4- Effective 3- Neither 2- Ineffective 1- Very Ineffective

    
    
38. Strengths
    
    
    
39. Areas for Development
    
    
    
40. Please give any final comments or suggestions for [Participant Name Here]'s assessment.
    
    

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Sample Results

Sample Result Document:
Sample Results