Agreement to Mediate

U.S. Department of Labor              Office of Administrative Law Judges
                                      200 Constitution Ave., NW
                                      Room S-4325
                                      Washington, DC 20210
                                      Mediation Program
                                      Alison G. Smith, Mediator
                                      smith.alison.g@dol.gov




     In the Matter of:

                                                                     OALJ Case No.(s) :


        v.




                                    AGREEMENT TO MEDIATE

             This is an agreement by the parties to mediate a complaint related to the above
     captioned claim pending before the Office of Administrative Law Judges (“OALJ”), U.S.
     Department of Labor. Use of mediation is a voluntary process which the parties or the mediator
     may terminate at any time. The mediator will not act as a representative for either party. Each
     party is encouraged to consult with an attorney, if they have not done so, before signing any
     agreement settling a case.

             Communications may be in writing, by electronic mail, or by telephone. An in-
     person conference may also be scheduled. The parties and their representatives will attend
     mediation sessions unless excused by the mediator. The mediator may suggest the additional
     participation of an expert or other person to assist in resolving an issue. No one else may
     participate without the permission of the parties and the consent of the mediator. The mediator
     may speak or meet with each party separately; in that event, the mediator will not reveal what
     is said by one party to the other(s) without permission. The parties agree to ex parte
     communications with the mediator in furtherance of the mediation process when either a party
     or the mediator considers it necessary or helpful.

            By signing this agreement, all participants acknowledge that all mediation sessions and
     material prepared for the exclusive use of the mediator are confidential and privileged and
     shall not be disclosed in any subsequent proceeding. Each party agrees not to subpoena the
     mediator or any documents submitted to the mediator unless those documents are otherwise
     discoverable. Under no circumstance will the mediator disclose confidential information
     provided during the course of mediation, testify voluntarily on behalf of either party, or submit
     any type of report to any court in connection with this case. The completed Agreement to
     Mediate and Request for Mediation forms are not considered confidential. To the extent that
                                                         1
the parties may have participated in an earlier mediation where confidentiality was agreed to,
confidential information exchanged during that procedure should not be submitted to the OALJ
mediator unless both parties agree to do so.

        With one exception, none of the mediation proceedings shall be construed for any
purpose as an admission against interest. In the event that a settlement is reached and a party
thereafter defaults and/or breaches the settlement agreement, then the written settlement
agreement itself [signed by the parties or their legal representatives] may be used as evidence
at any subsequent proceeding to enforce the agreement.

         The parties agree that the mediator has the discretion to terminate mediation at any time
if s/he believes the case is inappropriate for mediation or that an impasse has been reached.
Likewise, any party may withdraw from mediation at any time. Upon termination of the
mediation, the mediator will advise the Chief Administrative Law Judge and the presiding
Administrative Law Judge of the termination of the mediation and whether or not the parties
reached agreement.

       Settlement negotiations shall not normally exceed sixty (60) days, absent approval of
an extension request by the Chief Administrative Law Judge. (29 C.F.R. § 18.9(e)(4)).
Any settlement agreement disposing of all or a part of the proceeding shall be in writing,
conform to the requirements of 29 C.F.R. § 18.71, and be signed by the parties. Once a
settlement agreement is reached, the parties must submit the agreement and any required
documents to the presiding Administrative Law Judge within 14 calendar days of the
conclusion of the mediation unless the presiding Administrative Law Judge rules otherwise.


________________________________________________                   Date ____________________
                      ,
________________________________________________                   Date ____________________
                 ,
________________________________________________                   Date ____________________
                  ,

________________________________________________                   Date ____________________
                 ,

Certified By:

________________________________________________                   Date ____________________


________________________________________________                   Date ____________________
Assigned Mediator:



                                                                                    AGS 2 of 3
                               Additional Signatures




_______________________________________________        Date ____________________



_______________________________________________        Date ____________________



_______________________________________________        Date ____________________



_______________________________________________        Date ____________________



_______________________________________________        Date ____________________



_______________________________________________        Date ____________________



_______________________________________________        Date ____________________



_______________________________________________        Date ____________________



_______________________________________________        Date ____________________



_______________________________________________        Date ____________________




                                                              Revised 8.26.2025
                                                              AGS 3 of 3