Title Page

  • Month

  • Audit Title

  • Department

  • Conducted on

  • Conducted by:

  • Location
  • Director:

MMM Information

  • Date:

  • Director Name:

  • What's working well

  • Who can I recognize?


  • HCAHPS meeting goal?

  • Cleaning Score is meeting goal?

  • Is there evidence of AIDET Validations?

  • Is there evidence of Patient Rounding?

  • What has been learned from Patient rounding?

  • Is there evidence of the standard of the month being posted?

  • Evidence of internal customer rounding?

  • Does your department have a service excellence story for this month?

  • What is the story?


  • Is there evidence of Staff Rounding?

  • Staff rounding frequency and quality is consistent with goals?

  • Stoplight report is current, present, and posted?

  • Have 5 Thank You cards been written since the last meeting?

  • Is Employee Engagement (EE) Score at goal according to the most recent survey data available?

  • Have you completed/ updated your EE action plan?

  • What are some of the improvement tactics you are under taking?

  • Do you need any additional help to complete your action plan items?

  • Was 30/60/90 day discussions held and documented?

  • Have there been any H/S/L conversations since the last MMM?

  • What staff was identified as Low and why?


  • Productivity meeting goal?

  • Cost management meeting goal?

  • Contract compliance meeting goal?

  • Is the department using contract labor?

  • What is the plan to reduce contract labor?

  • Is the FPC current?

  • Department supply scanning rate meeting 90% goal?

  • Are any staff members on the incremental OT list?


  • Add location
  • Anything you are really proud of since your last MMM?

  • Anything you need from me at this time (prior to our next MMM)?

  • For our next MMM please ensure you have done the following:

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.