My illustration teacher, Dominic Catalano, had something very similar to this that he gave us as handouts. This is a very basic design that can be used to create thumbnails for your picturebook layouts. I refrained from writing any more than the basics on these pages so you can feel free to create as you'd like. Also you may not be using all of these pages (see the link below) but I didn't want to put any marks on this sheet.
I will reffer you to Tara Lazar's website which has tips on how to layout your dummy: http://taralazar.com/2009/02/22/picture-book-construction-know-your-layout/
I ask that you link to my pages when sharing this information. They both have the same information on these. Be sure to print these in landscape and not the portrait setting. If you have any issues with either of these please let me know!