I'm pretty sure that something so general is not copyright-able.  And why would you be offended that someone is copying your format?  I urge my abstractors to plagiarize  anything they want off my forms.  I have some very specific disclaimers (like not being liable for indexing errors on records maintained by others) that I wish everyone would use.

All of our forms are just different ways of presenting the same data.  Please don't be offended if someone likes how you display your work!  Be flattered.