Skip to main navigationSkip to main content
The University of Southampton
MediationMediation referrals

Referral form for managers

Use this Referral Form if you are a Manager/HR/Team Leader/Tutor etc wishing to refer a case involving staff and/or students.

    Referrer details

    Contact details

    Referrer's relationship with parties

    Please outline your working relationship with the parties (if applicable)

    Details of parties for mediation

    Contact details

    Details of case

    Please provide a brief summary of the situation, including if the issue(s) are part of a grievance or any other formal process.

    Actions relating to case

    Please provide brief details of any actions taken to date to resolve, investigate or otherwise manage the situation and their outcomes.

    Have you discussed mediation?

    Have you discussed the possibility of mediation with either of the parties involved?

    Consent for names being referred?

    If you have spoken to the parties, have one or both of them agreed to their names being referred to the Mediation Service. (Parties do not need to agree to mediation at this stage, just to agree to discuss it more fully before they make a decision)

    Venue requirements

    Are there any specific venue requirements (ie disabled access) for a mediation meeting with these parties?

    Any other relevant information

    If there is any other information you would like the Mediation Co-ordinator to be aware of please add your comments below.

    Thank you for completing this form. Once submitted you will be contacted by the Mediation Service shortly to discuss what happens next.

    Privacy Settings