Michelle, Have you addressed process performance from 5.6.2c? You may have it covered in the objectives, but it's not clear when the form is blank. It could meet the requirements, depending on what information you put into it.
Of course the real test to see if the form works for you is to try it out. If it's easy to use and reminds you to include all of the "right stuff" then it's great. If it's cumbersome and gets in the way, then tweak it some more or work something else out.