I have one (when I find it again) Basic outline is (from top to bottom):
Both parties information.
Table with 6 Cols: Item, Condition, Pick-up Lender, Pick-up Owner, Return Lender, Return Owner
Notes
Picked up (signatures of Lender, Owner. Date)
Returned (signatures of Lender, Owner. Date)
All thing done in triplicate.
Mine is printed up at the printers and bound, so I cannot show you a copy.