Minnesota Department of Labor and Industry

Mediation form submission



Alternative Dispute Resolution (ADR) unit – mediation request form



This online mediation request form is used to request a mediation session with an ADR mediator at the Department of Labor and Industry (DLI). The form gathers necessary information and allows users to select a preferred mediator and preferred mediation date and time. The submission will be sent to an ADR mediation scheduler for completion of the scheduling process.

A mediation request may also be made by contacting ADR at (651) 284-5005, 1-800-342-5354 or mediation.dli@state.mn.us.

To complete the mediation request form, the user will need the following information:
Selecting the mediator
The system provides a drop-down box listing all ADR mediators. Clicking on the mediator’s name will display the mediator’s already scheduled appointments; users should select a date when the mediator does not already have an appointment scheduled.

Selecting the preferred date
The system provides a box where the user may select their preferred mediation date and a box for a second preferred mediation date.

Additional information
The system provides a box where the user can provide additional information or special requests.

Submitting the form
After completing the form, the user should click “Submit.” A message will appear confirming the request was successfully sent and the form will be sent to ADR.



Minnesota Department of Labor and Industry
443 Lafayette Road N., St. Paul, MN  55155