I would start with the basics and create my own. There will be some things that won't be relevant in your situation that might be relevant in others and vice versa.
1. Operating Systems Supported
2. Disk space required
3. List of all files to be deployed and where they will be installed (and whether this is accomplished via an installation program or must be done manually)
4. Assumptions about other programs on the user's machine (e-mail client, database drivers, Word, Excel, etc.)
5. Minimum processor speed & memory
6. Any required other hardware (scanner, bar code reader, etc.)
7. Systems work that must be done to enable a user for the application (adding a user to a database & granting permissions, granting access to a certaindrive, etc.)
8. A list of all available documentation for the project (help files, training material, manuals, use cases, whatever).
For your situation, think of the last few "gotchas" that have happened after a deployment and add things to the form -- only you know your users and your developers.
Remember that the forms could be dynamic. As you discover something else that you wish was documented, add it to the template form and go back and add it to the existing ones, too.
