Blind playtester report form -- anyone got one?

I'm starting the blind playtest phase on a boardgame, and I need a form to send out to the playtesters for them to record their thoughts, opinions and verdicts. I was wondering if anyone had a standard form I could look at, to get an idea of 'prior art'.

I'm kind of startled that there isn't one already in the Downloads section. Obviously each game design is different but there'a standard data about each one that could be put together on a generic, customisable form that would save a lot of people a lot of trouble.

If I'm satisfied with the one I'm working on, I'll offer it up for download.