</script>
<div class="4u12u$(large)">
<input type="checkbox" id="hygiene" name="hygiene"><label for="hygiene">Hygiene</label>
<input type="checkbox" id="safety" name="safety"><label for="safety">Safety</label>
<input type="checkbox" id="pan" name="pan"><label for="pan">Pan/Wheel Chuck</label>
</div>